Efficacy of Mechanical Thrombectomy Using Stent Retriever and Balloon-Guiding Catheter

  • S. KammererEmail author
  • R. du Mesnil de Rochemont
  • M. Wagner
  • S. -J. You
  • S. Tritt
  • M. Mueller-Eschner
  • F. C. Keil
  • A. Lauer
  • J. Berkefeld
Clinical Investigation



Intra-arterial therapy of acute ischemic stroke has developed rapidly in recent years. Due to proven efficacy in randomized trials, stent retrievers were replacing first-generation thrombectomy devices and have been defined as method of choice. However, aspiration catheters or a combination of several techniques have shown promising rates of successful recanalizations. To create a basis for comparison of the new approaches according to real-world data, we determined the first pass recanalization rate of an evidence-based standard technique with the use of a stent retriever in combination with a balloon-guiding catheter. The assessment was based on the number of required passages and reperfusion rate, but not on clinical results.


Patients from our institution with anterior circulation occlusions and mechanical thrombectomy by using stent retrievers in combination with balloon-guiding catheters were analyzed retrospectively. Reperfusion was graded with the “thrombolysis in cerebral infarction” (TICI) classification on post-interventional angiograms. Additionally, the number of passes and the duration of the recanalization procedure were recorded.


Between 2014 and July 2017, 201 patients met the inclusion criteria. Successful recanalization, defined as a TICI scale 2b/3, was 91% (TICI 2b was achieved in 44% and TICI 3 in 47%) after the procedure. After the first passage, successful recanalization was achieved in 65% of the patients. Mean number of passes was 1.4 (1–5 passes) for all patients. Median duration of the procedure was 49 min (0:11–2:35 h).


Even a standard thrombectomy technique with the use of a stent retriever together with a balloon-guiding catheter provides reasonable recanalization rates with only one passage. The results can be taken as benchmark for alternative and more complex techniques.


Stroke Acute Endovascular therapy Thrombectomy Stent retriever thrombectomy 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

For this type of study formal consent is not required.

Informed Consent

Written informed consent was waived by the institutional review board.


  1. 1.
    Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947.CrossRefPubMedGoogle Scholar
  2. 2.
    Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. New Engl J Med. 2015;372:11–20.CrossRefPubMedGoogle Scholar
  3. 3.
    Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. New Engl J Med. 2015;372:1009–18.CrossRefPubMedGoogle Scholar
  4. 4.
    Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. New Engl J Med. 2015;372:1019–30.CrossRefPubMedGoogle Scholar
  5. 5.
    Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. New Engl J Med. 2015;372:2285–95.CrossRefPubMedGoogle Scholar
  6. 6.
    Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. New Engl J Med. 2015;372:2296–306.CrossRefPubMedGoogle Scholar
  7. 7.
    Wahlgren N, Moreira T, Michel P, 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.CrossRefPubMedGoogle Scholar
  8. 8.
    Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46:3020–35.CrossRefPubMedGoogle Scholar
  9. 9.
    Casaubon LK, Boulanger J-M, Blacquiere D, et al. Canadian stroke best practice recommendations: hyperacute stroke care guidelines, update 2015. Int J Stroke. 2015;10:924–40.CrossRefPubMedGoogle Scholar
  10. 10.
    Campbell BCV, Hill MD, Rubiera M, et al. Safety and efficacy of solitaire stent thrombectomy: individual patient data meta-analysis of randomized trials. Stroke. 2016;47:798–806.PubMedCentralPubMedGoogle Scholar
  11. 11.
    Saposnik G, Lebovic G, Demchuk A, et al. Added benefit of stent retriever technology for acute ischemic stroke: a pooled analysis of the NINDS tPA, SWIFT, and STAR trials. Neurosurgery. 2015;77:454–61.CrossRefPubMedGoogle Scholar
  12. 12.
    Grech R, Mizzi A, Pullicino R, Thornton J, Downer J. Functional outcomes and recanalization rates of stent retrievers in acute ischaemic stroke: a systematic review and meta-analysis. Neuroradiol J. 2015;28:152–71.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Wong JH, Do HM, Telischak NA, et al. Initial experience with SOFIA as an intermediate catheter in mechanical thrombectomy for acute ischemic stroke. J Neurointervent Surg. 2017;9:1103–6. CrossRefGoogle Scholar
  14. 14.
    Delgado Almandoz JE, Kayan Y, Young ML, et al. Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques. J Neurointervent Surg. 2016;8:1123–8.CrossRefGoogle Scholar
  15. 15.
    Lapergue B, Blanc R, Guedin P, et al. A direct aspiration, first pass technique (ADAPT) versus stent retrievers for acute stroke therapy: an observational comparative study. AJNR Am J Neuroradiol. 2016;37:1860–5.CrossRefGoogle Scholar
  16. 16.
    Madjidyar J, Hermes J, Freitag-Wolf S, Jansen O. Stent-thrombus interaction and the influence of aspiration on mechanical thrombectomy: evaluation of different stent retrievers in a circulation model. Neuroradiology. 2015;57:791–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Turk AS, Frei D, Fiorella D, et al. ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy. J Neurointervent Surg. 2014;6:260–4.CrossRefGoogle Scholar
  18. 18.
    Lozano JD, Massari F, Howk MC, et al. Utilization of a new intracranial support catheter as an intermediate aspiration catheter in the treatment of acute ischemic stroke: technical report on initial experience. Cureus. 2016;8:e617. PubMedCentralPubMedGoogle Scholar
  19. 19.
    Kang DH. Endovascular stroke therapy focused on stent retriever thrombectomy and direct clot aspiration: historical review and modern application. J Korean Neurosurg Soc. 2017;60:335–47.CrossRefPubMedCentralPubMedGoogle Scholar
  20. 20.
    Chueh J-Y, Puri AS, Wakhloo AK, Gounis MJ. Risk of distal embolization with stent retriever thrombectomy and ADAPT. J Neurointervent Surg. 2016;8:197–202. CrossRefGoogle Scholar
  21. 21.
    Maus V, Behme D, Kabbasch C, et al. Maximizing first-pass complete reperfusion with SAVE. Clin Neuroradiol. 2017. Google Scholar
  22. 22.
    Fields JD, Lindsay K, Liu KC, Nesbit GM, Lutsep HL. Mechanical thrombectomy for the treatment of acute ischemic stroke. Expert Rev Cardiovasc Ther. 2010;8:581–92.CrossRefPubMedGoogle Scholar
  23. 23.
    Fugate JE, Klunder AM, Kallmes DF. What is meant by “TICI”? AJNR Am J Neuroradiol. 2013;34:1792–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Lapergue B, Blanc R, Gory B, 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.CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Mueller-Kronast NH, Zaidat OO, Froehler MT, 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.CrossRefPubMedGoogle Scholar
  26. 26.
    Campbell BCV, Donnan GA, Lees KR, et al. Endovascular stent thrombectomy: the new standard of care for large vessel ischaemic stroke. Lancet Neurol. 2015;14:846–54.CrossRefPubMedGoogle Scholar
  27. 27.
    Matsumoto H, Nishiyama H, Tetsuo Y, Takemoto H, Nakao N. Initial clinical experience using the two-stage aspiration technique (TSAT) with proximal flow arrest by a balloon guiding catheter for acute ischemic stroke of the anterior circulation. J Neurointervent Surg. 2017;9:1160–5. CrossRefGoogle Scholar
  28. 28.
    McTaggart RA, Tung EL, Yaghi S, et al. Continuous aspiration prior to intracranial vascular embolectomy (CAPTIVE): a technique which improves outcomes. J Neurointervent Surg. 2017;9:1154–59. CrossRefGoogle Scholar
  29. 29.
    Mohlenbruch MA, Kabbasch C, Kowoll A, et al. Multicenter experience with the new SOFIA Plus catheter as a primary local aspiration catheter for acute stroke thrombectomy. J Neurointervent Surg. 2017;9:1223–7. CrossRefGoogle Scholar
  30. 30.
    Prothmann S, Friedrich B, Boeckh-Behrens T, et al. Aspiration thrombectomy in clinical routine interventional stroke treatment: is this the end of the stent retriever era? Clin Neuroradiol. 2017. PubMedGoogle Scholar
  31. 31.
    Stapleton CJ, Torok CM, Patel AB. 110 Noninferiority of a direct aspiration first-pass technique vs stent retriever thrombectomy in emergent large-vessel intracranial occlusions. Neurosurgery. 2016;63(Suppl 1):146–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Wei D, Mascitelli JR, Nistal DA, et al. The use and utility of aspiration thrombectomy in acute ischemic stroke: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2017;38:1978–83.CrossRefPubMedGoogle Scholar
  33. 33.
    Jansen O, Macho JM, Killer-Oberpfalzer M, Liebeskind D, Wahlgren N. Neurothrombectomy for the treatment of acute ischemic stroke: results from the TREVO Study. Cerebrovasc Dis. 2013;36:218–25.CrossRefPubMedGoogle Scholar
  34. 34.
    Vidal GA, Milburn JM. The penumbra 5MAX ACE catheter is safe, efficient, and cost saving as a primary mechanical thrombectomy device for large vessel occlusions in acute ischemic stroke. Ochsner J. 2016;16:486–91.PubMedCentralPubMedGoogle Scholar
  35. 35.
    Premat K, Bartolini B, Baronnet-Chauvet F, et al. Single-center experience using the 3MAX reperfusion catheter for the treatment of acute ischemic stroke with distal arterial occlusions. Clin Neuroradiol. 2017. PubMedGoogle Scholar
  36. 36.
    Maegerlein C, Prothmann S, Lucia KE, Zimmer C, Friedrich B, Kaesmacher J. Intraprocedural thrombus fragmentation during interventional stroke treatment: a comparison of direct thrombus aspiration and stent retriever thrombectomy. Cardiovasc Intervent Radiol. 2017;40:987–93.CrossRefPubMedGoogle Scholar
  37. 37.
    Hesse AC, Behme D, Kemmling A, et al. Comparing different thrombectomy techniques in five large-volume centers: a ‘real world’ observational study. J Neurointerv Surg. 2017. Google Scholar
  38. 38.
    Blanc R, Redjem H, Ciccio G, et al. Predictors of the aspiration component success of a direct aspiration first pass technique (ADAPT) for the endovascular treatment of stroke reperfusion strategy in anterior circulation acute stroke. Stroke. 2017;48:1588–93.CrossRefPubMedGoogle Scholar
  39. 39.
    Vargas J, Spiotta AM, Fargen K, Turner RD, Chaudry I, Turk A. Experience with ADAPT for thrombectomy in distal cerebral artery occlusions causing acute ischemic stroke. World Neurosurg. 2017;99:31–36. CrossRefPubMedGoogle Scholar
  40. 40.
    Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. New Engl J Med. 2017;378:11–21.CrossRefPubMedGoogle Scholar
  41. 41.
    Zaidat OO, Castonguay AC, Nogueira RG, et al. TREVO stent-retriever mechanical thrombectomy for acute ischemic stroke secondary to large vessel occlusion registry. J Neurointerv Surg. 2017. Google Scholar
  42. 42.
    Romano DG, Cioni S, Vinci SL, et al. Thromboaspiration technique as first approach for endovascular treatment of acute ischemic stroke: initial experience at nine Italian stroke centers. J Neurointervent Surg. 2017;9:6–10.CrossRefGoogle Scholar
  43. 43.
    Kabbasch C, Mohlenbruch M, Stampfl S, Mpotsaris A, Behme D, Liebig T. First-line lesional aspiration in acute stroke thrombectomy using a novel intermediate catheter: initial experiences with the SOFIA. Intervent Neuroradiol. 2016;22:333–9.CrossRefGoogle Scholar
  44. 44.
    Jankowitz B, Grandhi R, Horev A, et al. Primary manual aspiration thrombectomy (MAT) for acute ischemic stroke: safety, feasibility and outcomes in 112 consecutive patients. J Neurointervent Surg. 2015;7:27–31.CrossRefGoogle Scholar
  45. 45.
    Vargas J, Spiotta A, Fargen K, Turner R, Chaudry I, Turk A. Long term experience using the ADAPT technique for the treatment of acute ischemic stroke. J Neurointervent Surg. 2017;9:437–41.CrossRefGoogle Scholar
  46. 46.
    Peschillo S, Diana F, Colonnese C, et al. Real-time distal, multifocal, repeated lenticulostriate bleeding points during thrombectomy in a patient with acute variable M1 occlusion: a case report and a literature review. J Stroke Cerebrovasc Dis. 2017;26:2082–6.CrossRefPubMedGoogle Scholar
  47. 47.
    Jeong EO, Kwon HJ, Choi SW, Koh HS. Pseudoaneurysm formation after repetitive suction thrombectomy using a penumbra suction catheter. J Cerebrovasc Endovasc Neurosurg. 2016;18:296–301.CrossRefPubMedCentralPubMedGoogle Scholar
  48. 48.
    Brinjikji W, Starke RM, Murad MH, et al. Impact of balloon guide catheter on technical and clinical outcomes: a systematic review and meta-analysis. J Neurointerv Surg. 2017. Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Institute of NeuroradiologyUniversity Hospital of the Goethe-University Frankfurt, Goethe University FrankfurtFrankfurtGermany

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