Stent Retriever-Mediated Manual Aspiration Thrombectomy for Acute Ischemic Stroke

Jadhav, Ashutosh P; Aghaebrahim, Amin; Horev, Anat; Giurgiutiu, Dan‐Victor; Ducruet, Andrew F; Jankowitz, Brian T.; Jovin, Tudor G

doi:10.1159/000449321

Cited by 15 publications

(4 citation statements)

References 22 publications

(26 reference statements)

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“…Recanalization was achieved with a combination of stent retriever thrombectomy and manual aspiration as previously described. 12 The following postprocedural, clinical, and radiographic features were studied: quality of recanalization (original thrombolysis in cerebral infarction [TICI] 0-3), posttreatment infarct volume, presence of symptomatic intracranial hemorrhage (as defined by SITS-MOST criteria 13 (Safe Implementation of Thrombolysis in Stroke-Monitoring Study) of parenchymal hemorrhage type 2 on the 22-to 36-hour posttreatment imaging scan in the setting of a neurological decline of ≥4 points compared with baseline NIHSS score), and rates of mortality and functional independence (modified Rankin Scale score 0-2) at 90 days. The presence of symptomatic intracranial hemorrhage was determined by the treating vascular neurologist and separately adjudicated by an additional vascular neurologist not involved in the patient's care.…”

Section: Methodsmentioning

confidence: 99%

Interfacility Transfer Directly to the Neuroangiography Suite in Acute Ischemic Stroke Patients Undergoing Thrombectomy

Jadhav

Kenmuir

Aghaebrahim

et al. 2017

Stroke

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Background and Purpose-In patients identified at referring facilities with acute ischemic stroke caused by a large vessel occlusion, bypassing the emergency department (ED) with direct transport to the neuroangiography suite may safely shorten reperfusion times. Methods-We conducted a single-center retrospective review of consecutive patients transferred to our facility for consideration of endovascular therapy. Patients were identified as admitted directly to the neuroangiography suite (DAN), transferred to the ED before intra-arterial therapy (ED-IA), and transferred to the ED but did not receive IA therapy (ED-IV). Results-A retrospective review of a prospectively maintained database of transfer patients between January 2013 and October 2016 with large vessel occlusions identified 108 ED-IV patients and 261 patients who underwent mechanical thrombectomy (DAN=111 patients and ED-IA=150 patients). There were no differences in baseline characteristics among the 3 groups. The median computed tomography ASPECTS (Alberta Stroke Program Early CT Score) was lower in the ED-IV group versus the ED-IA and DAN groups (8 versus 9; P=0.001). In the DAN versus ED-IA cohort, there were comparable rates of TICI2b/3 recanalization and access to recanalization time. There was significantly faster hospital arrival to groin access time in the DAN cohort (81 minutes versus 22 minutes; P=0.001). Functional independence at 90 days was comparable in the DAN versus ED-IA cohorts but worse in the ED-IV group (43% versus 44% versus 22%; P=0.001). Conclusions-DAN is safe, feasible, and associated with faster times of hospital arrival to recanalization. The clinical benefit of this approach should be assessed in a prospective randomized trial.

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Section: Methodsmentioning

confidence: 99%

Interfacility Transfer Directly to the Neuroangiography Suite in Acute Ischemic Stroke Patients Undergoing Thrombectomy

Jadhav

Kenmuir

Aghaebrahim

et al. 2017

Stroke

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“…The concept of the BEMP technique using the Tron stent retriever for MCA M2 occlusion is to deploy the retriever and advance the DAC until it reaches the clot. Relatively similar techniques for proximal occlusions have been described, mostly consisting of single-arm studies (25)(26)(27)(28)(29)(30)(31) and some comparative studies (26,(30)(31)(32) showing that the combined use of contact aspiration and the stent retriever technique may be superior to either retriever or aspiration thrombectomy alone. However, there are few reports of techniques specifically analyzing MCA M2 occlusions.…”

Section: Safety Outcomesmentioning

confidence: 99%

Blind Exchange With Mini-Pinning Technique Using the Tron Stent Retriever for Middle Cerebral Artery M2 Occlusion Thrombectomy in Acute Ischemic Stroke

et al. 2021

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Introduction: The usefulness of the blind exchange with mini-pinning (BEMP) technique has recently been reported for mechanical thrombectomy in patients with stroke owing to medium vessel occlusion (MeVO). The Tron stent retriever can be delivered and deployed through a 0.0165-inch microcatheter. This retriever has potential as an effective and safe treatment for acute ischemic stroke (AIS) due to occlusion of the M2 segment of the middle cerebral artery (MCA). Here, we report the outcomes of the BEMP technique using Tron stent retrievers for M2 occlusion thrombectomy.Methods: Consecutive patients with AIS owing to M2 occlusion who underwent the BEMP technique using 2 × 15-mm or 4 × 20-mm Tron stent retrievers were included. The technique involves deploying a Tron stent retriever through a 0.0165-inch microcatheter, followed by microcatheter removal and blind navigation of a 3MAX or 4MAX aspiration catheter over the bare Tron delivery wire until the aspiration catheter reaches the clot. A Tron stent retriever is inserted into the aspiration catheter like a cork and subsequently pulled as a unit. We assessed procedural outcomes [first-pass expanded thrombolysis in cerebral infarction (eTICI) score 2c/3 and 2b/2c/3], safety outcomes [symptomatic intracranial hemorrhage (sICH)], and clinical outcomes (good outcome rate defined as modified Rankin Scale score 0–2 at 90 days and mortality at 90 days).Results: Eighteen M2 vessels were treated in 15 patients (six female, median age: 80 years, and median National Institutes of Health Stroke Scale score: 18). The BEMP technique was performed successfully in all cases. Whether to use a 3MAX or 4MAX catheter was determined by considering one of the following target vessels: dominant, non-dominant, or co-dominant M2 (3MAX, n = 9; 4MAX, n = 9). The first-pass eTICI 2c/3 and 2b/2c/3 rates were 47 (7/15) and 60% (9/15), respectively; sICH was not observed. Seven patients (47%) achieved good outcomes, and one patient (7%) died within 90 days.Conclusions: The Tron stent retriever was safely and effectively used in the BEMP technique for acute MCA M2 occlusion and can be combined with a 0.0165-inch microcatheter, which may be useful for treating MeVO, in general.

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“…The concept is to deploy the retriever and advance the aspiration catheter until it engages the clot. Relatively similar techniques have been described, mostly consisting of single-arm experiences10–13 and some comparative studies14–16 showing that it may be superior to either retriever or aspiration thrombectomy alone. The fundamental aim is to push the aspiration catheter slightly past the proximal end of the clot in order to ‘cork’ (partially ingest) the thrombus into the catheter.…”

Section: Discussionmentioning

confidence: 99%

Blind exchange with mini-pinning technique for distal occlusion thrombectomy

Haussen

Al‐Bayati

Eby

et al. 2019

J NeuroIntervent Surg

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IntroductionTechnical improvements to enhance distal occlusion thrombectomy are desirable. We describe the blind catheter exchange technique and report the pinning technique with small devices (‘mini-pinning’) for distal occlusions.MethodsA retrospective review of a prospective database from January 2015 to August 2018 was performed for cases of distal occlusion in which the ‘blind exchange/mini-pinning’ (BEMP) techniques were used. The technique involves the deployment of a 3 mm Trevo retriever followed by microcatheter removal and blind advancement of a 3MAX aspiration catheter over the bare retriever delivery wire (‘blind exchange’) until clot contact under aspiration. The retriever is subsequently partially recaptured in order to ‘cork’ the thrombus (‘mini-pinning’) and the system pulled as a unit. Patients with distal occlusions treated with BEMP and standard techniques (either 3 mm Trevo or 3MAX) were compared.ResultsTwenty-five vessels were treated in 22 patients. The majority of patients had isolated distal occlusions predominantly in the distal middle cerebral artery (MCA) segments, half of which involved the superior division. The comparison between BEMP (n=25 vessels) and standard techniques (n=144 vessels) revealed balanced groups. One of the highlighted differences was the more distal MCA occlusions among those who underwent BEMP (M3 occlusions 52% vs 22%; p=0.001). Otherwise, the vessel, segments, divisions and luminal diameter were comparable. There was a higher rate of first-pass modified Thrombolysis in Cerebral Infarction 2b–3 (80% vs 56%; p=0.03) and a trend towards higher rates of first-pass full reperfusion (60% vs 40%; p=0.07) with BEMP compared with standard techniques. Final reperfusion and clinical outcomes were comparable.ConclusionBEMP appears to be a safe and effective technique for the treatment of distal occlusions. Additional studies are warranted.

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Stent Retriever-Mediated Manual Aspiration Thrombectomy for Acute Ischemic Stroke

Cited by 15 publications

References 22 publications

Interfacility Transfer Directly to the Neuroangiography Suite in Acute Ischemic Stroke Patients Undergoing Thrombectomy

Interfacility Transfer Directly to the Neuroangiography Suite in Acute Ischemic Stroke Patients Undergoing Thrombectomy

Blind Exchange With Mini-Pinning Technique Using the Tron Stent Retriever for Middle Cerebral Artery M2 Occlusion Thrombectomy in Acute Ischemic Stroke

Blind exchange with mini-pinning technique for distal occlusion thrombectomy

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