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Aspiration thrombectomy in clinical routine interventional stroke treatment

Is this the end of the stent retriever era?

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Abstract

Purpose

The aim of our study was the technical evaluation of a first pass approach of primary thrombus aspiration (AST) in patients with emergency large intracerebral vessel occlusions (ELVO) under routine clinical conditions.

Materials and Methods

We collected procedural and clinical data of 104 patients who underwent mechanical thrombectomy due to ELVO between June 2014 and January 2016 with intentional first-line thrombus aspiration. Procedures were conducted due to occlusions of the distal internal carotid artery, middle cerebral artery, anterior cerebral artery, basilar artery and posterior cerebral artery and were performed with the patient under either conscious sedation or general anesthesia. If the AST technique failed completely or to some extent, stent retriever-based thrombectomy (SRT) was performed.

Results

As a stand-alone method AST was successful in achieving TICI (Thrombolysis in Cerebral Infarction) score 2b or 3 results in 29 cases (27.8%). After additional use of SRT successful recanalization was achieved in a total of 95 cases (91.3%, p = 0.048). If AST was performed exclusively, median procedure time until TICI 2b/3 was 15 min, in cases of combined procedures 35 min (p = 0.001). Subarachnoid hemorrhage (SAH) after thrombectomy appeared only if additional SRT was performed (12.0%) and not in cases of AST maneuvers alone (p = 0.09).

Conclusion

When used as a first pass attempt AST is a fast and safe approach for patients suffering from stroke due to ELVO. Nonetheless, early conversion to SRT is needed in most cases and leads to overall excellent procedural results with low complication rates.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany

    S. Prothmann, B. Friedrich, T. Boeckh-Behrens, C. Zimmer, J. Kaesmacher & C. Maegerlein

  2. Department of Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany

    K. Lucia

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  1. S. Prothmann
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Correspondence to C. Maegerlein.

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Conflict of interests

S. Prothmann is consultant for phenox GmbH, Bochum, Germany and Acandis GmbH & Co. KG, Pforzheim, Germany. CZ has served on scientific advisory boards for Philips and Bayer Schering; serves as co-editor on the advisory board of Clinical Neuroradiology; has received speaker honoraria from Bayer-Schering and Philips and has received research support and investigator fees for clinical studies from Biogen Idec, Quintiles, MSD Sharp & Dome, Boehringer Ingelheim, Inventive Health Clinical UK Ltd., Advance Cor, Brainsgate, Pfizer, Bayer-Schering, Novartis, Roche, Servier, Penumbra, WCT GmbH, Syngis, SSS International Clinical Research, PPD Germany GmbH, Worldwide Clinical Trials Ltd., Phenox, Covidien, Actelion, Medivation, Medtronic, Harrison Clinical Research, Concentric, Penumbra, Pharmtrace, Reverse Medical Corp., Premier Research Germany Ltd., Surpass Medical Ltd. and GlaxoSmithKline. B. Friedrich, T. Boeckh-Behrens, C. Zimmer, J. Kaesmacher, K. Lucia and C. Maegerlein declare that they have no competing interests.

Ethical standards

All investigations on humans described in this manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration from 1964 (in its current revised form). Informed consent was obtained from all patients included in this study.

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Prothmann, S., Friedrich, B., Boeckh-Behrens, T. et al. Aspiration thrombectomy in clinical routine interventional stroke treatment. Clin Neuroradiol 28, 217–224 (2018). https://doi.org/10.1007/s00062-016-0555-7

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