title: Outcomes of manual aspiration thrombectomy for acute ischemic stroke refractory to stent-based thrombectomy.
abstract: OBJECTIVE
  The optimal treatment for patients with acute stroke refractory to stent-based thrombectomy (SBT) is unclear. This study aimed to report clinical outcomes of manual aspiration thrombectomy (MAT) for the treatment of acute ischemic stroke refractory to SBT.
  
  
  METHODS
  We retrospectively analyzed clinical and angiographic data of 30 patients who underwent MAT with a Penumbra reperfusion catheter because of refractory occlusion after SBT with a Solitaire stent as first-line endovascular therapy. Refractory occlusion was defined by a lack of successful revascularization (defined as Thrombolysis In Cerebral Infarction ≥2b) after five retrieval attempts. A good outcome was defined as a modified Rankin scale score of ≤2 at 3 months.
  
  
  RESULTS
  Successful revascularization was achieved in 83.3% (25/30) of the patients who underwent MAT after failed SBT. There was no arterial rupture or dissection or symptomatic intracranial hemorrhage. Two embolic occlusions in a new arterial territory and five subarachnoid hemorrhages occurred, neither of which caused neurological worsening. At the 3-month follow-up, 36.7% (11/30) of patients exhibited a good outcome. The mortality rate was 6.7% (2/30) at 3 months.
  
  
  CONCLUSIONS
  This study suggests that MAT with the Penumbra reperfusion catheter can further increase the revascularization rate without serious complications in patients with acute stroke with refractory occlusions after SBT with a Solitaire stent.
authors.affiliation: Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Seul Kee
authors.initials: SK
authors.lastname: Kim
authors.affiliation: Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Woong
authors.initials: W
authors.lastname: Yoon
authors.affiliation: Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Sung Min
authors.initials: SM
authors.lastname: Moon
authors.affiliation: Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Man Seok
authors.initials: MS
authors.lastname: Park
authors.affiliation: Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Gwang Woo
authors.initials: GW
authors.lastname: Jeong
authors.affiliation: Department of Radiology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Heoung Keun
authors.initials: HK
authors.lastname: Kang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis* / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000639:trends*; D020521:Stroke / Q000175:diagnosis* / Q000601:surgery*; D017131:Thrombectomy / Q000639:trends*; D016896:Treatment Outcome
keywords: Intervention; Stroke; Thrombectomy