title: Direct thrombus retrieval using the reperfusion catheter of the penumbra system: forced-suction thrombectomy in acute ischemic stroke.
abstract: OBJECTIVE
  Although the PS has been the most promising mechanical thrombectomy device in terms of recanalization rates, even the PS cannot recanalize all cases of occlusion. Under such circumstances, we simply modified the PS, identified certain advantages, and applied this modification as a primary technique for recanalization. Here we describe and discuss the technical details and results of our preliminary experience.
  
  
  METHODS
  This study included 22 consecutive patients with acute ischemic stroke secondary to large-artery occlusion who underwent modified thrombectomy by using the PS for recanalization. Direct wedging between the tip of the reperfusion catheter and the proximal part of the clot followed by forceful suction by using a 20- or 50-mL syringe is a unique feature of this technique. What is distinctive is that this does not require use of a separator or aspiration pump.
  
  
  RESULTS
  All treated vessels (100%) were successfully recanalized. A TICI scale of 2b or 3 was achieved in 81.9% of patients. A 3-month favorable functional outcome (mRS score, 0-2) was achieved in 45.5% of patients. The only procedural complication was a transient dissection of the proximal ICA, which developed while advancing the guide catheter.
  
  
  CONCLUSIONS
  Forced-suction thrombectomy is a simple modification of the PS. On the basis of our data, this technique allows safe and effective revascularization in acute large-vessel occlusion. Thus, for achieving the best outcome, the modified PS technique is proposed as a viable option for acute stroke management, either by itself or in conjunction with other devices or drugs.
authors.affiliation: Department of Neuroradiology, Daegu-Gyeongbuk Cardiocerebrovascular Center, Kyungpook National University, Republic of Korea.
authors.forename: D-H
authors.initials: DH
authors.lastname: Kang
authors.forename: Y-H
authors.initials: YH
authors.lastname: Hwang
authors.forename: Y-S
authors.initials: YS
authors.lastname: Kim
authors.forename: J
authors.initials: J
authors.lastname: Park
authors.forename: O
authors.initials: O
authors.lastname: Kwon
authors.forename: C
authors.initials: C
authors.lastname: Jung
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D002404:Catheterization; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery*; D013396:Suction; D017131:Thrombectomy / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome