Efficacy of Mechanical Thrombectomy Using Stent Retriever and Balloon-Guiding Catheter
- 123 Downloads
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.
KeywordsStroke Acute Endovascular therapy Thrombectomy Stent retriever thrombectomy
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
For this type of study formal consent is not required.
Written informed consent was waived by the institutional review board.
- 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
- 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. https://doi.org/10.7759/cureus.617 PubMedCentralPubMedGoogle Scholar
- 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. https://doi.org/10.1136/neurintsurg-2016-012787 CrossRefGoogle Scholar
- 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