Primary manual aspiration thrombectomy (MAT) for acute ischemic stroke: safety, feasibility and outcomes in 112 consecutive patients

Abstract

Aim To describe procedural aspects and clinical outcomes in a consecutive series of patients in whom manual aspiration thrombectomy (MAT) was performed as the first treatment modality with other techniques used only in case MAT did not yield recanalization. Methods A retrospective review of a prospectively acquired acute stroke intervention database was performed. Primary MAT was carried out with a preference for the largest catheter considered to be trackable into the target occlusive lesion. The catheter was wedged into the thrombus followed by manual aspiration with a 20 ml syringe. Results 112 consecutive patients were evaluated. The median age was 66 years and the median NIH Stroke Scale score was 17. Occlusion locations included the M1 (62%), M2 (8%), internal carotid artery terminus (19%) and the vertebrobasilar artery (11%). Patients with anterior occlusions had tandem extracranial/intracranial occlusive lesions in 18.7% Median time from symptom onset to groin puncture was 267 min, and from groin puncture to recanalization was 70 min. Successful recanalization (defined as Thrombolysis in Cerebral Infarction (TICI) 2b/3) with primary MAT was 59% with a median of two passes. 41% of patients required the use of adjunctive therapy yielding an overall recanalization rate of TICI 2b/3 (86%) and TICI 3 (30.6%). Parenchymal hematoma of any type (PH1/PH2) was seen in 9.8% of patients, with symptomatic hemorrhage in 6%. Favorable outcomes (90-day modified Rankin Scale ≤2) were 46%. Mortality at 3 months was 31%. Primary MAT was associated with faster procedural times (mean 63 vs 97 min, p<0.0001) but not with higher rates of favorable outcomes. Conclusions Primary MAT is an alternative endovascular recanalization technique with reasonable first pass efficacy that will likely improve with technology and experience.

Clinical and Procedural Predictors of Outcomes From the Endovascular Treatment of Posterior Circulation Strokes

“…None of the 18 patients treated with aspiration thrombectomy required the use of stent retrievers or other rescue therapy. Jankowitz et al 10 in their series of 112 patients with aspiration thrombectomy (of which only 12 patients had posterior circulation strokes) reported 41% rate of conversion for adjunct therapy, which mostly included stent retriever. Given the variability in procedural details, a prospective randomized study is needed to definitively determine whether one of the thrombectomy approaches is superior to the other.…”

“…6 Outside of clinical trials, endovascular therapy of posterior circulation strokes with stent retrievers and modern distal aspiration catheters is currently offered to a variety of patients using different selection criteria and treatment approaches, resulting in a wide range of clinical outcomes. [7][8][9][10] However, clinical and imaging predictors of success outcomes, and optimal recanalization approaches in this specific group of patients are not understood as well as in anterior circulation strokes because posterior circulation strokes have not been studied extensively. The aim of this study was to review our recent multicenter experience with endovascular treatment of …”

Comparison of Vacuum Pressures and Forces Generated by Different Catheters and Pumps for Aspiration Thrombectomy in Acute Ischemic Stroke

“…Furthermore, there are now several options for aspiration pumps. While the Penumbra system has offered an electrical pump since its inception [13], many interventionalists have opted for manual aspiration with a large syringe [14,15]. There is also the relatively new ASPIRE aspiration pump that has been used for peripheral thrombectomy [16] and consists of a handle-actuated, modified syringe with valves to allow for continuous vacuum generation while purging aspirated blood.…”

Clinical and Angiographic Outcomes with the Combined Local Aspiration and Retriever in the North American Solitaire Stent-Retriever Acute Stroke (NASA) Registry

“…In contrast, previous clinical reports addressing either local clot aspiration, base catheter aspiration, or nonaspiration techniques have not allowed direct comparisons of these techniques [30,31,32,33]. …”