Stent retrieval thrombectomy in acute stoke is facilitated by the concurrent use of intracranial aspiration catheters. (1st September 2016) - Jindal, Gaurav
Abstract : Background: New device technology has changed the techniques used for revascularization of emergent large vessel occlusion in acute stroke. We report technical results using stent retrievers (SRs) for thrombectomy alone versus SRs used in conjunction with a new group of devices, intracranial aspiration catheters (IACs). Our aim is to demonstrate differences in procedural time and thrombectomy attempts between these two groups. Methods: A retrospective evaluation was performed of a prospectively maintained database of 97 patients treated at a single institution for anterior circulation stroke with SRs. Patients were divided into two groups, a combination group defined as the SR/IAC group and the SR alone group defined as the SR group. Results: Patients in the SR/IAC group had a mean age of 66 years vs 59 years in the SR group (p=0.008). Mean presenting National Institutes of Health Stroke Scale (NIHSS) scores in the SR/IAC and control groups were 18.7 and 18.2, respectively (p=0.50). Recanalization rates (Thrombolysis In Cerebral Infarction (TICI) 2b or 3) in the SR/IAC and SR groups were 85% (58/68) and 90% (26/29), respectively (p=0.41). Mean time from groin arteriotomy to recanalization was 50±3.6 min (range 19–136) in the SR/IAC group (n=59) and 61±6.6 min (range 28–140) in the SR group (n=27) (p=0.049). The total number of thrombectomy attempts in the SR/IAC and SR groups were 1.9±0.1 (range 1–4) and 2.5±0.6 (range 1–6), respectively (p=0.009). Post-procedural subarachnoid hemorrhage was seen in 15% (10/68) and 10% (3/29) of cases in the SR/IAC and SR groups, respectively (p=0.41). Conclusion: When using SRs for intracranial stroke thrombectomy, the concurrent use of IACs is associated with a decrease in procedural time and thrombectomy attempts compared with use of SRs alone.