, Volume 54, Issue 11, pp 1261–1265 | Cite as

Manual aspiration thrombectomy through balloon-tipped guide catheter for rapid clot burden reduction in endovascular therapy for ICA L/T occlusion

  • Muneer Eesa
  • Mohammed A. Almekhlafi
  • Alim P. Mitha
  • John H. Wong
  • Mayank Goyal
Interventional Neuroradiology



Timely recanalization during endovascular procedures for acute ischemic stroke can be challenging in cases with large clot burden, such as those encountered in the terminal internal carotid T- or L-type occlusion.


A novel but simple technique to achieve fast reduction in clot burden in stroke patients with occlusion of the internal carotid artery termination is described where manual suction using a 60-ml syringe applied through an 8-F balloon guide catheter positioned in the cervical carotid vasculature with proximal flow arrest allows subsequent revascularization of the residual middle cerebral artery clot.


The use of manual suction through a balloon-tipped guide catheter in internal carotid artery L- or T-type occlusion is illustrated. This resulted in a significant reduction of the clot burden and facilitated further interventions leading to full recanalization.


Manual suction using a 60-ml syringe through a ballon guide catheter is a useful and feasible technique that facilitates thrombectomy of large burden cerebral clots.


Aspiration Embolectomy Stroke 


Conflict of interest

Dr. Goyal has received honoraria from Penumbra Inc. for speaking engagements and from ev3/Covidien as a consultant for education and trial design. The rest of the authors have no conflict of interest.


  1. 1.
    Bhatia R, Hill MD, Shobha N, Menon B, Bal S, Kochar P, Watson T, Goyal M, Demchuk AM (2010) Low rates of acute recanalization with intravenous recombinant tissue plasminogen activator in ischemic stroke: real-world experience and a call for action. Stroke 41(10):2254–2258PubMedCrossRefGoogle Scholar
  2. 2.
    Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II Study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 282(21):2003–2011PubMedCrossRefGoogle Scholar
  3. 3.
    Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS, Gobin YP, Lutsep HL, Nesbit GM, Grobelny T, Rymer MM, Silverman IE, Higashida RT, Budzik RF, Marks MP (2005) Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 36(7):1432–1438PubMedCrossRefGoogle Scholar
  4. 4.
    Bose A, Henkes H, Alfke K, Reith W, Mayer TE, Berlis A, Branca V, Sit SP (2008) The Penumbra system: a mechanical device for the treatment of acute stroke due to thromboembolism. AJNR Am J Neuroradiol 29(7):1409–1413PubMedCrossRefGoogle Scholar
  5. 5.
    Machi P, Costalat V, Lobotesis K, Lima Maldonado I, Vendrell JF, Riquelme C, Bonafe A (2012) Solitaire FR thrombectomy system: immediate results in 56 consecutive acute ischemic stroke patients. J Neurointerv Surg 4(1):62–66PubMedCrossRefGoogle Scholar
  6. 6.
    Frei D, Turk A, Heck D, Hui F, Joseph G, Jahan R, Carpenter J, Grobelny T, Goddard J, Leader B, Bose A, Sit S (2011) The SPEED trial: a study of the Penumbra early evacuation device. Paper presented at the International Stroke Conference Los Angeles, 01 Mar 2011Google Scholar
  7. 7.
    Hesselmann V, Niederstadt T, Dziewas R, Ritter M, Kemmling A, Maintz D, Koehler M, Seifarth H, Jacobs AH, Ringelstein EB, Heindel W (2012) Reperfusion by combined thrombolysis and mechanical thrombectomy in acute stroke: effect of collateralization, mismatch, and time to and grade of recanalization on clinical and tissue outcome. AJNR Am J Neuroradiol 33:336–342PubMedCrossRefGoogle Scholar
  8. 8.
    Goyal M, Menon BK, Coutts SB, Hill MD, Demchuk AM (2011) Effect of baseline CT scan appearance and time to recanalization on clinical outcomes in endovascular thrombectomy of acute ischemic strokes. Stroke 42(1):93–97PubMedCrossRefGoogle Scholar
  9. 9.
    Gralla J, Burkhardt M, Schroth G, El-Koussy M, Reinert M, Nedeltchev K, Slotboom J, Brekenfeld C (2008) Occlusion length is a crucial determinant of efficiency and complication rate in thrombectomy for acute ischemic stroke. AJNR Am J Neuroradiol 29(2):247–252PubMedCrossRefGoogle Scholar
  10. 10.
    King S, Khatri P, Carrozella J, Spilker J, Broderick J, Hill M, Tomsick T (2007) Anterior cerebral artery emboli in combined intravenous and intra-arterial rtPA treatment of acute ischemic stroke in the IMS I and II trials. AJNR Am J Neuroradiol 28(10):1890–1894PubMedCrossRefGoogle Scholar
  11. 11.
    Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JP, Brott T, Frankel M, Grotta JC, Haley EC Jr, Kwiatkowski T, Levine SR, Lewandowski C, Lu M, Lyden P, Marler JR, Patel S, Tilley BC, Albers G, Bluhmki E, Wilhelm M, Hamilton S (2004) Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363(9411):768–774PubMedCrossRefGoogle Scholar
  12. 12.
    Wester P, Radberg J, Lundgren B, Peltonen M (1999) Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA: a prospective, multicenter study. Seek-Medical-Attention-in-Time Study Group. Stroke 30(1):40–48PubMedCrossRefGoogle Scholar
  13. 13.
    Tan IY, Demchuk AM, Hopyan J, Zhang L, Gladstone D, Wong K, Martin M, Symons SP, Fox AJ, Aviv RI (2009) CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol 30(3):525–531PubMedCrossRefGoogle Scholar
  14. 14.
    Kulcsar Z, Bonvin C, Pereira VM, Altrichter S, Yilmaz H, Lovblad KO, Sztajzel R, Rufenacht DA (2010) Penumbra system: a novel mechanical thrombectomy device for large-vessel occlusions in acute stroke. AJNR Am J Neuroradiol 31(4):628–633PubMedCrossRefGoogle Scholar
  15. 15.
    Brekenfeld C, Schroth G, Mordasini P, Fischer U, Mono ML, Weck A, Arnold M, El-Koussy M, Gralla J (2011) Impact of retrievable stents on acute ischemic stroke treatment. AJNR Am J Neuroradiol 32(7):1269–1273PubMedCrossRefGoogle Scholar
  16. 16.
    Lutsep HL, Clark WM, Nesbit GM, Kuether TA, Barnwell SL (2002) Intraarterial suction thrombectomy in acute stroke. AJNR Am J Neuroradiol 23(5):783–786PubMedGoogle Scholar
  17. 17.
    Xu GF, Suh DC, Choi CG, Kim JK, Kim W, Kim SJ, Kim JS (2005) Aspiration thrombectomy of acute complete carotid bulb occlusion. J Vasc Interv Radiol 16(4):539–542PubMedCrossRefGoogle Scholar
  18. 18.
    Imai K, Mori T, Izumoto H, Takabatake N, Kunieda T, Shimizu H, Watanabe M (2006) Clot removal therapy by aspiration and extraction for acute embolic carotid occlusion. AJNR Am J Neuroradiol 27(7):1521–1527PubMedGoogle Scholar
  19. 19.
    Fesl G, Wiesmann M, Patzig M, Holtmannspoetter M, Pfefferkorn T, Dichgans M, Brueckmann H (2006) Endovascular mechanical recanalisation of acute carotid-T occlusions: a single-center retrospective analysis. Cardiovasc Intervent Radiol 34(2):280–286CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Muneer Eesa
    • 1
  • Mohammed A. Almekhlafi
    • 2
    • 4
  • Alim P. Mitha
    • 2
    • 3
  • John H. Wong
    • 2
    • 3
  • Mayank Goyal
    • 1
    • 2
    • 5
  1. 1.Department of RadiologyUniversity of CalgaryCalgaryCanada
  2. 2.Department of Clinical NeurosciencesUniversity of CalgaryCalgaryCanada
  3. 3.Department of NeurosurgeryUniversity of CalgaryCalgaryCanada
  4. 4.Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
  5. 5.Seaman Family MR Research CenterFoothills Medical CenterCalgaryCanada

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