title: Maximizing First-Pass Complete Reperfusion with SAVE.
abstract: BACKGROUND
  Endovascular techniques for treatment of large vessel occlusions (LVO) in patients with acute ischemic stroke (AIS) have advanced in recent years. We report a multicenter experience using a combined aspiration and stent retriever technique for mechanical thrombectomy (MT).
  
  
  METHODS
  We retrospectively analyzed 32 consecutive MT patients using a novel, combined approach of Stent retriever Assisted Vacuum-locked Extraction (SAVE) by 3 operators at 3 stroke centers. Primary endpoint was successful first-pass reperfusion with a modified Thrombolysis in Cerebral Infarction (mTICI) score of 3. Secondary endpoints were number of passes, time from groin puncture to reperfusion, embolization to new territories (ENT), postinterventional symptomatic intracranial hemorrhage (sICH) and clinical outcome at discharge.
  
  
  RESULTS
  First-pass mTICI 3 reperfusion was achieved in 23 out of 32 patients (72%) with a mean groin puncture to reperfusion time of 36.0 min ± 15.8 and mTICI 3 was accomplished in 25 out of 32 cases (78%) with a maximum of 3 attempts. Successful reperfusion (mTICI ≥ 2b) was achieved in all patients (100%) with a mean time from groin puncture to reperfusion of 44.5 min ± 25.8 and an average of 1.2 ± 0.7 attempts. The rate of ENT was 0% and 1 patient with sICH after MT died on postoperative day 4. At discharge, the median National Institutes of Health Stroke Scale (NIHSS) score was 4 (range 0-17) and favorable neurological outcome by the modified Rankin score (mRS ≤ 2) was achieved in 19 out of 32 patients (59%).
  
  
  CONCLUSIONS
  SAVE is fast and appears to be very effective in terms of first-pass complete reperfusion in patients with LVO.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany. volker.maus@uk-koeln.de.
authors.forename: Volker
authors.initials: V
authors.lastname: Maus
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Göttingen, Göttingen, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Behme
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Kabbasch
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Borggrefe
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Göttingen, Göttingen, Germany.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tsogkas
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Hospital of Aachen, Aachen, Germany.
authors.forename: Omid
authors.initials: O
authors.lastname: Nikoubashman
authors.affiliation: Department of Diagnostic and Interventional Neuroradiology, University Hospital of Aachen, Aachen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Wiesmann
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Göttingen, Göttingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Knauth
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
authors.forename: Anastasios
authors.initials: A
authors.lastname: Mpotsaris
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Göttingen, Göttingen, Germany.
authors.forename: Marios Nikos
authors.initials: MN
authors.lastname: Psychogios
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D015424:Reperfusion; D012189:Retrospective Studies; D015607:Stents; D020521:Stroke / Q000628:therapy*; D017131:Thrombectomy; D016896:Treatment Outcome
keywords: Acute ischemic stroke; Large vessel occlusion; Mechanical thrombectomy; SAVE