title: Optimizating Clot Retrieval in Acute Stroke: The Push and Fluff Technique for Closed-Cell Stentrievers.
abstract: OBJECTIVE
  We aimed to investigate the safety and efficacy of the Push and Fluff technique (PFT) as compared with the standard unsheathing technique for closed-cell stent retrievers in acute ischemic stroke.
  
  
  METHODS
  Acute ischemic stroke thrombectomy database was analyzed (September 2010 to January 2015) with the Trevo Retriever as a primary strategy. The PFT was compared with our internal standard unsheathing technique and with the Trevo Versus Merci Retrievers for Thrombectomy Revascularization of Large Vessel Occlusions in Acute Ischemic Stroke 2 (TREVO2) trial. Additionally, a silicon flow model was used to compare cell size/configuration, wall apposition/device diameter, and degree of foreshortening/device length across the 2 techniques.
  
  
  RESULTS
  One hundred fifty-one out of 662 patients qualified for the study. The PFT (n=71) was associated with higher rates of first-pass reperfusion (54% versus 35%, P=0.03; 54% versus 32.6%, P<0.01), lower number of passes (1.3±0.8 versus 1.8±1.0, P<0.01; 1.7±1.0 versus 2.4±1.6, P<0.01), and higher rates of modified treatment in cerebral ischemia-3 reperfusion (58% versus 40%, P=0.03; 58% versus 14%, P<0.01) as compared with the standard unsheathing technique (n=81) and the TREVO2 Trevo arm (n=88), respectively. No differences in hemorrhagic complications were observed across the groups. The in vitro model indicated that, compared with standard unsheathing technique, PFT resulted in improved wall apposition (device diameter, 75% larger) and cell size (mean area, 51% larger) at the cost of a mild degree of foreshortening (25% length reduction).
  
  
  CONCLUSIONS
  The PFT is safe and leads to optimization of wall apposition and cell size/configuration, resulting in higher chances of first-pass reperfusion, lower number of passes, and better rates of complete reperfusion.
authors.affiliation: From the Emory University School of Medicine/Marcus Stroke and Neuroscience Center-Grady Memorial Hospital, Atlanta, GA.
authors.forename: Diogo C
authors.initials: DC
authors.lastname: Haussen
authors.affiliation: From the Emory University School of Medicine/Marcus Stroke and Neuroscience Center-Grady Memorial Hospital, Atlanta, GA.
authors.forename: Leticia C
authors.initials: LC
authors.lastname: Rebello
authors.affiliation: From the Emory University School of Medicine/Marcus Stroke and Neuroscience Center-Grady Memorial Hospital, Atlanta, GA. raul.g.nogueira@emory.edu.
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000295:instrumentation* / Q000379:methods*
keywords: cell size; human; reperfusion; stent; stroke