Clinical Neuroradiology

, Volume 29, Issue 4, pp 669–676 | Cite as

The SAVE Technique

Large-Scale Experience for Treatment of Intracranial Large Vessel Occlusions
  • Volker Maus
  • Silja Henkel
  • Alexander Riabikin
  • Christian Riedel
  • Daniel Behme
  • Ioannis Tsogkas
  • Amelie Carolina Hesse
  • Nuran Abdullayev
  • Olav Jansen
  • Martin Wiesmann
  • Anastasios Mpotsaris
  • Marios-Nikos PsychogiosEmail author
Original Article



The stent retriever assisted vacuum-locked extraction (SAVE) technique was introduced as an effective thrombectomy method in stroke patients suffering from intracranial large vessel occlusion (LVO). This article presents our multicenter, large-scale experience with SAVE.


The study involved a retrospective core team analysis of 200 patients undergoing mechanical thrombectomy using the SAVE technique due to intracranial LVO at 4 German centers. Primary endpoints were first-pass and overall complete/near complete reperfusion, defined as a modified thrombolysis in cerebral infarction (mTICI) score of 2c and 3. Secondary endpoints were the number of passes, time from groin puncture to reperfusion, embolization to new territories (ENT), postinterventional symptomatic intracranial hemorrhage (sICH), and favorable outcome at discharge, defined as a modified Rankin Scale (mRS) score ≤ 2.


The median age was 78 years (interquartile range IQR 68–85). Median National Institutes of Health stroke scale (NIHSS) at admission was 16 (IQR 12–20). Occlusions sites were: internal carotid artery (ICA-T) in 39/200 (19.5%), M1 in 126/200 (63%), M2 in 30/200 (15%), and others in 5/200 (2.5%) cases. The primary endpoints were documented in 114/200 (57% first pass mTICI 2c or 3) and 154/200 (77% overall mTICI 2c or 3) patients, respectively. The overall median time from groin puncture to reperfusion was 34 min (IQR 25–52) with a median of 1 (IQR 1–2) attempts. An ENT was observed in 3 patients (1.5%) and the rate of sICH was 2.6%. The rate of successful reperfusion (mTICI ≥ 2b) on final angiograms was 95%. At discharge, 73/200 (36.5%) patients revealed a favorable outcome.


Mechanical thrombectomy using the SAVE technique seems to be effective, fast and safe. First-line use of SAVE leads to high rates of complete and near complete reperfusion.


Ischemic stroke Mechanical thrombectomy Stent-retriever SAVE Large vessel occlusion 


Compliance with ethical guidelines

Conflict of interest

D. Behme Consultant: Phenox; speakers fees: Siemens, Styker, Penumbra. M. Wiesmann worked as a consultant and received reimbursement for lectures or travel support: Stryker Neurovascular; received reimbursement for lectures or travel support: Bracco Imaging, Medtronic, Siemens Healthcare, Abbott. A. Mpotsaris consultancy (modest fees): Neuravi, Penumbra, Sequent Medical. M.-N. Psychogios: travel grant, fees: Styker, Phenox, Penumbra, Acandis, Siemens. V. Maus, S. Henkel, A. Riabikin, C. Riedel, I. Tsogkas, A.C. Hesse, N. Abdullayev and O. Jansen declare that they have no competing interests.

Ethical standards

According to the guidelines of the respective local ethics committees, ethical approval was given when necessary (University Medical Center Göttingen) for this anonymous retrospective study, which was conducted in accordance to the Declaration of Helsinki. A patient’s consent for treatment was obtained according to the individual institutional guidelines. Due to the retrospective nature of the study additional informed consent was deemed unnecessary.

Supplementary material

62_2018_702_MOESM1_ESM.docx (57 kb)
The table in the electronic supplementary material shows the executed strategies in randomized trials and retrospective studies with angiographic and technical results including the first-pass reperfusion rate, the final reperfusion rate, procedural times, number of passes, occurrence of ENT and sICH.


  1. 1.
    Baek J‑H, Yoo J, Song D, Kim YD, Nam HS, Kim BM, et al. Predictive value of thrombus volume for recanalization in stent retriever thrombectomy. Sci Rep. 2017;7:15938.CrossRefGoogle Scholar
  2. 2.
    Berkhemer OA, Fransen PSS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. A randomized trial of intraarterial treatment for acute Ischemic stroke. N Engl J Med. 2015;372:11–20.CrossRefGoogle Scholar
  3. 3.
    Campbell BCV, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372:1009–18.CrossRefGoogle Scholar
  4. 4.
    Campbell BCV, Hill MD, Rubiera M, Menon BK, Demchuk A, Donnan GA, et al. Safety and efficacy of solitaire stent thrombectomy: individual patient data meta-analysis of randomized trials. Stroke. 2016;47(3):798–806. Scholar
  5. 5.
    Goto S, Ohshima T, Ishikawa K, Yamamoto T, Shimato S, Nishizawa T, et al. A Stent-Retrieving into an Aspiration Catheter with Proximal Balloon (ASAP) technique: a technique of mechanical thrombectomy. World Neurosurg. 2018;109:e468–e75.CrossRefGoogle Scholar
  6. 6.
    Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of Ischemic stroke. N Engl J Med. 2015;372:1019–30.CrossRefGoogle Scholar
  7. 7.
    Hesse AC, Behme D, Kemmling A, Zapf A, Große Hokamp N, Frischmuth I, et al. Comparing different thrombectomy techniques in five large-volume centers: a “real world” observational study. J Neurointerv Surg. 2018;10(6):525–9. CrossRefPubMedGoogle Scholar
  8. 8.
    Higashida RT, Furlan AJ. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003;34:e109–37.CrossRefGoogle Scholar
  9. 9.
    Humphries W, Hoit D, Doss VT, Elijovich L, Frei D, Loy D, et al. Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke. J Neurointerv Surg. 2015;7:90–4.CrossRefGoogle Scholar
  10. 10.
    Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372:2296–306.CrossRefGoogle Scholar
  11. 11.
    Kannath SK, Rajan JE, Sylaja PN, Sarma PS, Sukumaran S, Sreedharan SE, et al. Dwell time of stentriever influences complete revascularization and first-pass TICI 3 revascularization in acute large vessel occlusive stroke. World Neurosurg. 2018;110:169–73.CrossRefGoogle Scholar
  12. 12.
    Kowoll A, Weber A, Mpotsaris A, Behme D, Weber W. Direct aspiration first pass technique for the treatment of acute ischemic stroke: initial experience at a European stroke center. J Neurointerv Surg. 2016;8:230–4.CrossRefGoogle Scholar
  13. 13.
    Lapergue B, Blanc R, Gory B, Labreuche J, Duhamel A, Marnat G, et al. Effect of endovascular contact aspiration vs stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion: The ASTER randomized clinical trial. JAMA. 2017;318:443–52.CrossRefGoogle Scholar
  14. 14.
    Maegerlein C, Mönch S, Boeckh-Behrens T, Lehm M, Hedderich DM, Berndt MT, et al. PROTECT: PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy—evaluation of a double embolic protection approach in endovascular stroke treatment. J Neurointerv Surg. 2017; Scholar
  15. 15.
    Massari F, Henninger N, Lozano JD, Patel A, Kuhn AL, Howk M, et al. ARTS (Aspiration-Retriever Technique for Stroke): Initial clinical experience. Interv Neuroradiol. 2016;22:325–32.CrossRefGoogle Scholar
  16. 16.
    Maus V, Behme D, Kabbasch C, Borggrefe J, Tsogkas I, Nikoubashman O, et al. Maximizing first-pass complete reperfusion with SAVE. Clin Neuroradiol. 2017; Scholar
  17. 17.
    McTaggart RA, Tung EL, Yaghi S, Cutting SM, Hemendinger M, Gale HI, et al. Continuous aspiration prior to intracranial vascular embolectomy (CAPTIVE): a technique which improves outcomes. J Neurointerv Surg. 2017;9:1154–9.CrossRefGoogle Scholar
  18. 18.
    Mocco J, Zaidat OO, von Kummer R, Yoo AJ, Gupta R, Lopes D et al. Aspiration thrombectomy after intravenous alteplase versus intravenous alteplase alone. Stroke. 2016;47:2331–8.CrossRefGoogle Scholar
  19. 19.
    Möhlenbruch MA, Kabbasch C, Kowoll A, Broussalis E, Sonnberger M, Müller M, et al. Multicenter experience with the new SOFIA Plus catheter as a primary local aspiration catheter for acute stroke thrombectomy. J Neurointerv Surg. 2017;9:1223–7.CrossRefGoogle Scholar
  20. 20.
    Mueller-Kronast NH, Zaidat OO, Froehler MT, Jahan R, Aziz-Sultan MA, Klucznik RP, et al. Systematic evaluation of patients treated with neurothrombectomy devices for acute ischemic stroke: primary results of the STRATIS registry. Stroke. 2017;48:2760–8.CrossRefGoogle Scholar
  21. 21.
    Nguyen TN, Malisch T, Castonguay AC, Gupta R, Sun CHJ, Martin CO, et al. Balloon guide catheter improves revascularization and clinical outcomes with the solitaire device: analysis of the north american solitaire acute stroke registry. Stroke. 2014;45:141–5.CrossRefGoogle Scholar
  22. 22.
    Pereira VM, Gralla J, Davalos A, Bonafé A, Castaño C, Chapot R, et al. Prospective, multicenter, single-arm study of mechanical thrombectomy using solitaire flow restoration in acute ischemic stroke. Stroke. 2013;44:2802–7.CrossRefGoogle Scholar
  23. 23.
    Psychogios M‑N, Behme D, Schregel K, Tsogkas I, Maier IL, Leyhe JR, et al. One-stop management of acute stroke patients: minimizing door-to-reperfusion times. Stroke. 2017;48:3152–5.CrossRefGoogle Scholar
  24. 24.
    Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, et al. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet. 2012;380:1241–9.CrossRefGoogle Scholar
  25. 25.
    Saver JL, Goyal M, Bonafe A, Diener H‑C, Levy EI, Pereira VM, et al. Stent-retriever thrombectomy after intravenous t‑PA vs. t‑PA alone in stroke. N Engl J Med. 2015;372:2285–95.CrossRefGoogle Scholar
  26. 26.
    Schwaiger BJ, Gersing AS, Zimmer C, Prothmann S. The curved MCA: influence of vessel anatomy on recanalization results of mechanical thrombectomy after acute ischemic stroke. AJNR Am J Neuroradiol. 2015;36:971–6.CrossRefGoogle Scholar
  27. 27.
    Velasco A, Buerke B, Stracke CP, Berkemeyer S, Mosimann PJ, Schwindt W, et al. Comparison of a balloon guide catheter and a non-balloon guide catheter for mechanical thrombectomy. Radiology. 2016;280:169–76.CrossRefGoogle Scholar
  28. 28.
    Wahlgren N, Moreira T, Michel P, Steiner T, Jansen O, Cognard C, et al. Mechanical thrombectomy in acute ischemic stroke: consensus statement by ESO-Karolinska stroke update 2014/2015, supported by ESO, ESMINT, ESNR and EAN. Int J Stroke. 2016;11:134–47.CrossRefGoogle Scholar
  29. 29.
    Wiesmann M, Brockmann M‑A, Heringer S, Müller M, Reich A, Nikoubashman O. Active push deployment technique improves stent/vessel-wall interaction in endovascular treatment of acute stroke with stent retrievers. J Neurointerv Surg. 2017;9:253–6.CrossRefGoogle Scholar
  30. 30.
    Zaidat OO, Yoo AJ, Khatri P, Tomsick TA, Von Kummer R, Saver JL, et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke. 2013;44:2650–63. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Zaidat OO, Bozorgchami H, Ribó M, Saver JL, Mattle HP, Chapot R, et al. Primary results of the multicenter ARISE II study (analysis of revascularization in Ischemic stroke with embotrap). Stroke. 2018;49(5):1107–15. Scholar
  32. 32.
    Zaidat OO, Castonguay AC, Linfante I, Gupta R, Martin CO, Holloway WE, et al. First pass effect: a new measure for stroke thrombectomy devices. Stroke. 2018;49(3):660–6. Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Volker Maus
    • 1
  • Silja Henkel
    • 1
  • Alexander Riabikin
    • 2
  • Christian Riedel
    • 3
  • Daniel Behme
    • 1
  • Ioannis Tsogkas
    • 1
  • Amelie Carolina Hesse
    • 1
  • Nuran Abdullayev
    • 4
  • Olav Jansen
    • 3
  • Martin Wiesmann
    • 2
  • Anastasios Mpotsaris
    • 2
  • Marios-Nikos Psychogios
    • 1
    Email author
  1. 1.Department of NeuroradiologyUniversity Medical Center GöttingenGöttingenGermany
  2. 2.Department of NeuroradiologyUniversity Hospital AachenAachenGermany
  3. 3.Department of Radiology and NeuroradiologyUniversity Hospital KielKielGermany
  4. 4.Department of RadiologyUniversity Hospital CologneCologneGermany

Personalised recommendations