PROTECT: PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy – evaluation of a double embolic protection approach in endovascular stroke treatment. (8th December 2017)

• Record Type: Journal Article
• Authors: Maegerlein, Christian; Mönch, Sebastian; Boeckh-Behrens, Tobias; Lehm, Manuel; Hedderich, Dennis M; Berndt, Maria Teresa; Wunderlich, Silke; Zimmer, Claus; Kaesmacher, Johannes; Friedrich, Benjamin
• Is Part Of: Journal of neurointerventional surgery. Volume 10:Number 8(2018)
• Page Start: 751
• Page End: 755
• Publication Date: 2017-12-08
• Subjects: balloon -- embolic -- intervention -- stroke; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2017-013558
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Purpose: Stent retriever-based mechanical thrombectomy (MT) for emergent large vessel occlusions (ELVO) is often complicated by thrombus fragmentation causing distal embolization and embolization to new vascular territories. Well-established embolic protection approaches include proximal flow arrest and distal aspiration techniques during stent retriever maneuvers. Aiming at the reduction of thrombus fragmentation during MT we evaluated a technical approach combining proximal balloon occlusion together with direct thrombus aspiration during MT: the PROTECT technique. Methods: We performed a case-control study comparing the PROTECT technique with sole distal aspiration during MT regarding technical and procedural parameters, n=200 patients with ELVO of either the terminus of the internal carotid artery or the proximal middle artery were included. Results: PROTECT resulted in a shorter procedure time (29 vs 40 min; P=0.002), in a higher rate of successful recanalizations (100% vs 78%; P=0.001) and a higher rate of complete reperfusions (70% vs 39%; P<0.001) compared with sole distal aspiration during MT. Conclusion: The PROTECT technique is a promising new approach to significantly reduce thrombus fragmentation and, hence distal embolization during MT. This safe and efficient technique needs to be validated in larger trials to confirm our results.