title: Manual aspiration thrombectomy: adjunctive endovascular recanalization technique in acute stroke interventions.
abstract: OBJECTIVE
  We evaluated recanalization rates, clinical outcomes, and safety when manual aspiration thrombectomy is used in conjunction with other thrombolytic modalities in a consecutive case series of patients with large vessel intracranial occlusion.
  
  
  METHODS
  We conducted a retrospective review of a prospectively acquired acute endovascular stroke database. Manual aspiration thrombectomy was carried out with Distal Access and Penumbra reperfusion catheters of different sizes placed in the thrombus and aspirated with a syringe.
  
  
  RESULTS
  We identified 191 patients: Occlusion locations were as follows: M1% to 50%, M2% to 10%, internal carotid artery terminus 25%, and vertebrobasilar 15%. Median treatment duration was 90 minutes. Recanalization results were Thrombolysis in Myocardial Ischemia 2/3 93%, Thrombolysis in Myocardial Ischemia 3 27%, Thrombolysis In Cerebral Infarction 2a/2b/3 91%, Thrombolysis In Cerebral Infarction 2b/3 71%, and Thrombolysis In Cerebral Infarction 3 25%. Larger catheters were associated with higher recanalization rates. Parenchymal hematoma rate was 13.6%. The favorable outcome (90-day modified Rankin Scale ≤ 2) rate was 54%. Mortality at 90 days was 25%.
  
  
  CONCLUSIONS
  Manual aspiration thrombectomy is a useful addition to the armamentarium of endovascular treatment modalities for acute stroke.
authors.affiliation: Stroke Institute, Pittsburgh, PA 15218, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Jankowitz
authors.forename: Amin
authors.initials: A
authors.lastname: Aghaebrahim
authors.forename: Alexandra
authors.initials: A
authors.lastname: Zirra
authors.forename: Oana
authors.initials: O
authors.lastname: Spataru
authors.forename: Syed
authors.initials: S
authors.lastname: Zaidi
authors.forename: Mouhammad
authors.initials: M
authors.lastname: Jumaa
authors.forename: Gerardo
authors.initials: G
authors.lastname: Ruiz-Ares
authors.forename: Michael
authors.initials: M
authors.lastname: Horowitz
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
mesh_terms: D000368:Aged; D000465:Algorithms; D002561:Cerebrovascular Disorders / Q000150:complications / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000601:surgery*; D013396:Suction / Q000009:adverse effects / Q000379:methods; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome