title: ARTS (Aspiration-Retriever Technique for Stroke): Initial clinical experience.
abstract: BACKGROUND
  A new generation of highly navigable large-bore aspiration catheters and retriever devices for intracranial mechanical thrombectomy has markedly improved recanalization rates, time and clinical outcomes. We report collected clinical data utilizing a new technique based on combined large lumen aspiration catheter and partially resheathed stent retriever (ARTS: Aspiration (catheter)-(stent) Retriever Technique for Stroke). This technique is applied, especially in presence of bulky/rubbery emboli, when resistance is felt while retracting the stent retriever; at that point the entire assembly is locked and removed in-toto under continuous aspiration with additional flow arrest.
  
  
  METHODS
  A retrospective data analysis was performed to identify patients with large cerebral artery acute ischemic stroke treated with ARTS. The study was conducted between August 2013 and February 2015 at a single high volume stroke center. Procedural and clinical data were captured for analysis.
  
  
  RESULTS
  Forty-two patients (median age 66 years) met inclusion criteria for this study. The ARTS was successful in achieving Thrombolysis in Cerebral Infarction (TICI) ≥2b revascularization in 97.6% of cases (TICI 2b = 18 patients, TICI 3 = 23 patients). Patients' median National Institutes of Health Stroke Scale score at admission was 18 (6-40). A 3-month follow-up modified Rankin Scale value of 0-2 was achieved in 65.7% of the successfully treated patients (average 2.4). Two patients (4.8%) developed symptomatic intraparenchymal hemorrhages. Six procedure unrelated deaths were observed.
  
  
  CONCLUSIONS
  We found that ARTS is a fast, safe and effective method for endovascular recanalization of large vessel occlusions presenting within the context of acute ischemic stroke.
authors.affiliation: Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA massarimd@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Massari
authors.affiliation: Departments of Neurology and Psychiatry, University of Massachusetts, Worcester, USA.
authors.forename: Nils
authors.initials: N
authors.lastname: Henninger
authors.affiliation: Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA.
authors.forename: Juan Diego
authors.initials: JD
authors.lastname: Lozano
authors.affiliation: Departments of Neurology and Psychiatry, University of Massachusetts, Worcester, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Patel
authors.affiliation: Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA.
authors.forename: Anna Luisa
authors.initials: AL
authors.lastname: Kuhn
authors.affiliation: Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Howk
authors.affiliation: Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Perras
authors.affiliation: Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Brooks
authors.affiliation: Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gounis
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Kan
authors.affiliation: Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Wakhloo
authors.affiliation: Division Neuroimaging and Intervention (NII) and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA.
authors.forename: Ajit S
authors.initials: AS
authors.lastname: Puri
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D057785:Catheters; D000072226:Computed Tomography Angiography; D004867:Equipment Design; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D061185:Mechanical Thrombolysis / Q000295:instrumentation*; D018579:Patient Selection; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery*; D013396:Suction; D016896:Treatment Outcome
keywords: Stroke; TICI; aspiration catheter; mechanical thrombectomy; stent retriever