Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke.
OBJECTIVE
Flexible large lumen aspiration catheters and stent retrievers have recently become available in the USA for the revascularization of large vessel occlusions presenting within the context of acute ischemic stroke (AIS). We describe a multicenter experience using a combined aspiration and stent retrieval technique for thrombectomy.


METHODS
A retrospective analysis to identify patients receiving combined manual aspiration and stent retrieval for treatment of AIS between August 2012 and April 2013 at six high volume stroke centers was conducted. Outcome variables, including recanalization rate, post-treatment National Institutes of Health Stroke Scale (NIHSS) score, symptomatic intracranial hemorrhage, discharge 90 day modified Rankin Scale (mRS) score, and mortality were evaluated.


RESULTS
105 patients were found that met the inclusion criteria for this retrospective study. Successful recanalization (Thrombolysis in Cerebral Infarction score 2B) was achieved in 92 (88%) of these patients. 44% of patients had favorable (mRS score 0-2) outcomes at 90 days. There were five (4.8%) symptomatic intracerebral hemorrhages and three procedure related deaths (2.9%).


CONCLUSIONS
Mechanical thrombectomy utilizing combined manual aspiration with a stent retriever is an effective and safe strategy for endovascular recanalization of large vessel occlusions presenting within the context of AIS.
Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute and University of Tennessee, Memphis, Tennessee, USA.
William
W
Humphries
Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute and University of Tennessee, Memphis, Tennessee, USA.
Daniel
D
Hoit
Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute and University of Tennessee, Memphis, Tennessee, USA.
Vinodh T
VT
Doss
Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute and University of Tennessee, Memphis, Tennessee, USA.
Lucas
L
Elijovich
Radiology Imaging Associates, Swedish Medical Center, Englewood, Colorado, USA.
Donald
D
Frei
Radiology Imaging Associates, Swedish Medical Center, Englewood, Colorado, USA.
David
D
Loy
Radiology Imaging Associates, Swedish Medical Center, Englewood, Colorado, USA.
Gwen
G
Dooley
Departments of Neurosurgery and Radiology, Medical University of South Carolina, Charleston, South Carolina, USA.
Aquilla S
AS
Turk
Departments of Neurosurgery and Radiology, Medical University of South Carolina, Charleston, South Carolina, USA.
Imran
I
Chaudry
Departments of Neurosurgery and Radiology, Medical University of South Carolina, Charleston, South Carolina, USA.
Raymond
R
Turner
Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
J
J
Mocco
Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Peter
P
Morone
Department of Neurosurgery, State University of New York-Stonybrook, Stonybrook, New York, USA.
David
D
Fiorella
Department of Neurosurgery, State University of New York-Buffalo, Buffalo, New York, USA.
Adnan
A
Siddiqui
Department of Neurosurgery, State University of New York-Buffalo, Buffalo, New York, USA.
Maxim
M
Mokin
Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute and University of Tennessee, Memphis, Tennessee, USA.
Adam S
AS
Arthur
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000175:diagnosis* / Q000601:surgery*; D013396:Suction / Q000379:methods; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
Stent; Stroke; Thrombectomy