Primary Aspiration Technique in Endovascular Stroke Treatment

Lukas Meyer, Maria Politi, Maria Alexandrou, Christian Roth, Freimuth Brunner, Andreas Kastrup, Panagiotis Papanagiotou

Abstract


Purpose: To investigate the safety and efficacy of “Primary Aspiration Technique” as an initial approach for intracranial artery occlusions in treatment of acute ischaemic stroke.

Material and Methods: A total of 107 patients with acute large intracerebral artery occlusions located in the anterior or posterior circulation were included in the study. All the patients were treated with “Primary Aspiration Technique” by using either the Penumbra ACE or the ACE 64 aspiration catheter (Penumbra Inc.). Recanalisation results were assessed by follow-up angiography immediately after the procedure. Neurological evaluation using the National Institutes of Health Stroke Scale and modified Rankin Scale (mRS) was performed on admission and at discharge.

Results: “Primary Aspiration Technique” alone was successfully used in 65% of the cases. The overall recanalisation rates were achieved in 88.8% of the cases. In 37 of the 107 cases (35%) secondary stent retriever devices were used in addition. If primary aspiration was successful, the median time from groin puncture until final recanalisation was 32 minutes.

An early good clinical outcome at discharge (mRS ≤2) was seen in a total of 50 patients (47%). In-hospital mortality was 15% (16/107). 58.6% (41/70) of the patients achieved an early good clinical outcome (mRS ≤2) when primary aspiration technique was successful.

By performing primary aspiration in different vessels the chance of receiving a Thrombolysis In Cerebral Infarction score ≥2b in the middle cerebral artery was 2.3 times higher than in the terminal internal carotid artery.

Conclusions: “Primary Aspiration Technique” is a safe and effective endovascular thrombectomy method. The main advantages of aspiration technique are the fast procedure time and the high rate of favourable clinical outcome if primary aspiration is successful.


Keywords


acute ischaemic stroke; mechanical thrombectomy; aspiration

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References


Rothwell PM, Coull AJ, Silver LE, et al. Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study). Lancet 2005; 366: 1773-1783.

Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372: 2285-2295.

Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372: 1019-1030.

Jovin TG, Chamorro Á, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372: 2296-2306.

Berkhemer OA, Fransen PSS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372: 11-20.

Campbell BCV, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372: 1009-1018.

Spiotta AM, Chaudry MI, Hui FK, Turner RD, Kellogg RT, Turk AS. Evolution of thrombectomy approaches and devices for acute stroke: A technical review. J Neurointerv Surg 2015; 7: 2-7.

Grunwald IQ, Walter S, Papanagiotou P, et al. Revascularization in acute ischaemic stroke using the penumbra system: The first single center experience. Eur J Neurol 2009; 16: 1210-1216.

Papanagiotou P, Roth C, Walter S, et al. Treatment of acute cerebral artery occlusion with a fully recoverable intracranial stent: A new technique. Circulation 2010; 121: 2605-2606.

Papanagiotou P, White CJ. Endovascular reperfusion strategies for acute stroke. JACC Cardiovasc Interv 2016; 9: 307-317.

Roth C, Papanagiotou P, Behnke S, et al. Stent-assisted mechanical recanalization for treatment of acute intracerebral artery occlusions. Stroke 2010; 41: 2559-2567.

Roth C, Reith W, Walter S, et al. Mechanical recanalization with flow restoration in acute ischemic stroke: The ReFlow (mechanical recanalization with flow restoration in acute ischemic stroke) study. JACC Cardiovasc Interv 2013; 6: 386-391.

Penumbra Pivotal Stroke Trial Investigators. The penumbra pivotal stroke trial: Safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke 2009; 40: 2761-2768.

Turk AS, Spiotta A, Frei D, et al. Initial clinical experience with the ADAPT technique: A direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg 2014; 6: 231-237.

Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387: 1723-1731.

Kastrup A, Brunner F, Wasser K, et al. Endovascular therapy vs. thrombolysis in patients with anterior circulation stroke in everyday clinical practice. Int J Stroke 2016; 11: 544-548.

Kowoll A, Weber A, Mpotsaris A, et al. Direct aspiration first pass technique for the treatment of acute ischemic stroke: Initial experience at a European stroke center. J Neurointerv Surg 2016; 8: 230-234.


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