title: Aspiration thrombectomy in clinical routine interventional stroke treatment : Is this the end of the stent retriever era?
abstract: OBJECTIVE
  The aim of our study was the technical evaluation of a first pass approach of primary thrombus aspiration (AST) in patients with emergency large intracerebral vessel occlusions (ELVO) under routine clinical conditions.
  
  
  METHODS
  We collected procedural and clinical data of 104 patients who underwent mechanical thrombectomy due to ELVO between June 2014 and January 2016 with intentional first-line thrombus aspiration. Procedures were conducted due to occlusions of the distal internal carotid artery, middle cerebral artery, anterior cerebral artery, basilar artery and posterior cerebral artery and were performed with the patient under either conscious sedation or general anesthesia. If the AST technique failed completely or to some extent, stent retriever-based thrombectomy (SRT) was performed.
  
  
  RESULTS
  As a stand-alone method AST was successful in achieving TICI (Thrombolysis in Cerebral Infarction) score 2b or 3 results in 29 cases (27.8%). After additional use of SRT successful recanalization was achieved in a total of 95 cases (91.3%, p = 0.048). If AST was performed exclusively, median procedure time until TICI 2b/3 was 15 min, in cases of combined procedures 35 min (p = 0.001). Subarachnoid hemorrhage (SAH) after thrombectomy appeared only if additional SRT was performed (12.0%) and not in cases of AST maneuvers alone (p = 0.09).
  
  
  CONCLUSIONS
  When used as a first pass attempt AST is a fast and safe approach for patients suffering from stroke due to ELVO. Nonetheless, early conversion to SRT is needed in most cases and leads to overall excellent procedural results with low complication rates.
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Prothmann
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Friedrich
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Boeckh-Behrens
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Zimmer
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Kaesmacher
authors.affiliation: Department of Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Lucia
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany. christian.maegerlein@tum.de.
authors.forename: C
authors.identifier: http://orcid.org/0000-0003-4885-7671
authors.initials: C
authors.lastname: Maegerlein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000628:therapy*; D008297:Male; D009426:Netherlands; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*; D010959:Tissue Plasminogen Activator; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator
keywords: ADAPT; Aspiration; Mechanical thrombectomy; Stent retriever; Stroke