title: Thromboaspiration technique as first approach for endovascular treatment of acute ischemic stroke: initial experience at nine Italian stroke centers.
abstract: OBJECTIVE
  Aspiration thrombectomy of large vessel occlusions has made a comeback among recanalization techniques thanks to recent advances in catheter technology resulting in faster recanalization and promising clinical results when used either alone or as an adjunct to stent retriever. This multicenter retrospective study reports angiographic data, complications, and clinical outcome in patients treated with aspiration thrombectomy as the first-line option.
  
  
  METHODS
  We analysed the clinical and procedural data of patients treated from January 2014 to March 2015. Recanalization was assessed according to the Thrombolysis in Cerebral Infarction score. Clinical outcome was evaluated at discharge and after 3 months.
  
  
  RESULTS
  Overall, 152 patients (mean age 68 years) were treated. Sites of occlusion were 90.8% anterior circulation (including 16.4% tandem extracranial/intracranial occlusions) and 9.2% basilar artery. In 79 patients administration of intravenous tissue plasminogen activator was attempted. Recanalization of the target vessel was obtained in 115/152 cases (75.6%) whereas direct aspiration alone was successful in 83/152 cases (54.6%) with an average puncture to revascularization time of 44.67 min. Symptomatic intracranial hemorrhage occurred in 7.8% and embolization to new territories in 1.9%. 77 patients (50.6%) had a good outcome at 90-day follow-up: 55/96 in the direct aspiration alone group and 22/56 in the aspiration-stent retriever group.
  
  
  CONCLUSIONS
  Direct aspiration thrombectomy appears a feasible technique with good revascularization results achieved in more than half the patients. In light of the self-reported data, inhomogeneous patient selection, absence of a core imaging laboratory, and a non-standardized approach, the results should be validated in a larger trial.
authors.affiliation: Department of Neurological Sciences, Division of Diagnostic and Interventional Neuroradiology, University Hospital of Siena, Italy.
authors.forename: D G
authors.identifier: http://orcid.org/0000-0002-7357-7770
authors.initials: DG
authors.lastname: Romano
authors.affiliation: Department of Neurological Sciences, Division of Diagnostic and Interventional Neuroradiology, University Hospital of Siena, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Cioni
authors.affiliation: Neuroradiology Unit, Department of Radiological Sciences, University of Messina, Messina, Italy.
authors.forename: S L
authors.initials: SL
authors.lastname: Vinci
authors.affiliation: Neuroradiology Department, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pero
authors.affiliation: Department of Interventional Radiology and Neuroradiology, S. Giovanni Bosco Emergencies Hospital, Turin, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Comelli
authors.affiliation: Department of Radiology, Central Hospital of Bolzano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Comai
authors.affiliation: Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology, "Sapienza" University of Rome, Rome, Italy.
authors.forename: S
authors.identifier: http://orcid.org/0000-0002-3920-8517
authors.initials: S
authors.lastname: Peschillo
authors.affiliation: Department of Neuroradiology, Spedali Civili, University of Brescia, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Mardighian
authors.affiliation: Neuroradiology Unit, San Martino Hospital-IST-IRCCS, Genoa, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Castellan
authors.affiliation: Department of Cardiology, University of Bari, Bari, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Resta
authors.affiliation: Neuroradiology Department, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: M G
authors.initials: MG
authors.lastname: Piano
authors.affiliation: Department of Interventional Radiology and Neuroradiology, S. Giovanni Bosco Emergencies Hospital, Turin, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Comelli
authors.affiliation: Neuroradiology Unit, San Martino Hospital-IST-IRCCS, Genoa, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Barletta
authors.affiliation: Department of Neurological Sciences, Division of Diagnostic and Interventional Neuroradiology, University Hospital of Siena, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Puliti
authors.affiliation: Department of Neurological Sciences, Division of Diagnostic and Interventional Neuroradiology, University Hospital of Siena, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Leonini
authors.affiliation: Department of Neurological Sciences, Division of Diagnostic and Interventional Neuroradiology, University Hospital of Siena, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bracco
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000601:surgery; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator
keywords: Angiography; Device; Stroke; Thrombectomy