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Impact and Effectiveness of Dual Aspiration Technique in Stent-Assisted Mechanical Thrombectomy: Recent Improvements in Acute Stroke Management

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Abstract

Background and Purpose

To evaluate feasibility and impact of dual aspiration technique (DAT) within stent-assisted mechanical thrombectomy on procedural parameters and clinical outcome.

Materials and Methods

Within 16 months, 76 consecutive patients (mean age 70.7 year; range 33–89) underwent stent-assisted mechanical thrombectomy. Of 52 enrolled patients (68.4 %) with occlusion of the anterior circulation, 22 patients (42.3 %) underwent DAT; 30 patients (57.7 %) were treated in conventional monoaspiration technique (MAT). Epidemiological data, clinical and imaging characteristics (mRS, NIHSS, ASPECTS) as well as procedural details were analyzed (TICI, number of retrieval, procedure time). Clinical outcome was determined with mRS at discharge and after 90 days.

Results

In the context of DAT additional carotid artery stenting was required in 45.5 % (10/22) in underlying tandem lesion (vs. 0/30 MAT). No differences were found in NIHSS at admission (MAT: 20.5, range 15–29; DAT: 18.6; range 11–25), mRS at admission (MAT: 4.6 vs. DAT: 4.57) or ASPECT score (MAT: 8.3, ±1.5; DAT: 8.4, ±1.5; P > 0.05). TICI ≥ 2b/3 was conducted in 90 % (MAT) and 100 % (DAT), respectively. The procedure time was longer in the MAT group (65 min, ±25.9, range 18–126) compared to the DAT group (49.7 min, ±15, range 32–101; P = 0.016). The clinical outcome increased from admission to discharge and in follow-up after 90 days (mRS ≥ 2: MAT: 53.3 %, DAT: 54.5 %; P > 0.05).

Conclusions

The dual aspiration technique with an additional intermediate guide catheter placed closed to the stent retriever leads to decreased procedure time in the anterior circulation. Even in cases with higher thrombus load and treated in DAT, clinical outcome improved.

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Fig. 1
Fig. 2

Abbreviations

MAT:

Monoaspiration technique

DAT:

Dual aspiration technique

CCA:

Common carotid artery

ICA:

Internal carotid artery

MCA:

Middle cerebral artery

CAS:

Carotid angioplasty and stenting

IGC:

Intermediate guide catheter

GC:

Guide catheter

References

  1. Mordasini P, Zubler C, Hsieh KWV, Chan PK, Gralla J. Stent-retriever thrombectomy: impact on the future of interventional stroke treatment. Clin Neuroradiol. 2014;4(1):17–22.

    Article  Google Scholar 

  2. Wahlgren N, Moreira T, Michel P, Steiner T, Jansen O, Cognard C, Mattle HP, van Zwam W, Holmin S, Tatlisumak T, Petersson J, Caso V, Hacke W, Mazighi M, Arnold M, Fischer U, Szikora I, Pierot L, Fiehler J, Gralla J, Fazekas F, Lees KR, ESO-KSU, ESO, ESMINT, ESNR, EAN. Mechanical thrombectomy in acute ischemic stroke: Consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN. Int J Stroke. 2016;11(1):134–47.

    Article  PubMed  Google Scholar 

  3. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, MR CLEAN Investigators, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372:11–20.

    Article  PubMed  Google Scholar 

  4. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, du Mesnil de Rochemont R, Singer OC, Jahan R, SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285–95.

    Article  CAS  PubMed  Google Scholar 

  5. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, Roy D, Jovin TG, Willinsky RA, Sapkota BL, Dowlatshahi D, Frei DF, Kamal NR, Montanera WJ, Poppe AY, Ryckborst KJ, Silver FL, Shuaib A, Tampieri D, Williams D, Bang OY, Baxter BW, Burns PA, Choe H, Heo JH, Holmstedt CA, Jankowitz B, Kelly M, Linares G, Mandzia JL, Shankar J, Sohn SI, Swartz RH, Barber PA, Coutts SB, Smith EE, Morrish WF, Weill A, Subramaniam S, Mitha AP, Wong JH, Lowerison MW, Sajobi TT, Hill MD, ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–30.

    Article  CAS  PubMed  Google Scholar 

  6. Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, Yan B, Dowling RJ, Parsons MW, Oxley TJ, Wu TY, Brooks M, Simpson MA, Miteff F, Levi CR, Krause M, Harrington TJ, Faulder KC, Steinfort BS, Priglinger M, Ang T, Scroop R, Barber PA, McGuinness B, Wijeratne T, Phan TG, Chong W, Chandra RV, Bladin CF, Badve M, Rice H, de Villiers L, Ma H, Desmond PM, Donnan GA, Davis SM, EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–18.

    Article  CAS  PubMed  Google Scholar 

  7. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, SanRomán L, Serena J, Abilleira S, Ribó M, Millán M, Urra X, Cardona P, López-Cancio E, Tomasello A, Castaño C, Blasco J, Aja L, Dorado L, Quesada H, Rubiera M, Hernandez-Pérez M, Goyal M, Demchuk AM, von Kummer R, Gallofré M, Dávalos A, REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296–306.

    Article  CAS  PubMed  Google Scholar 

  8. Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, SWIFT Trialists, et al. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet. 2012;380:1241–9.

    Article  PubMed  Google Scholar 

  9. Nogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, TREVO 2 Trialists, et al. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet. 2012;380:1231–40.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pereira VM, Gralla J, Davalos A, Bonafé A, Castaño C, Chapot R, et al. Prospective, multicenter, single-arm study of mechanical thrombectomy using Solitaire Flow Restoration in acute ischemic stroke. Stroke. 2013;44:2802–7.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chueh JY, Wakhloo AK, Gounis MJ. Effectiveness of mechanical endovascular thrombectomy in a model system of cerebrovascular occlusion. AJNR Am J Neuroradiol. 2012;33:1998–2003.

    Article  CAS  PubMed  Google Scholar 

  12. Przybylowski CJ, Ding D, Starke RM, Durst CR, Crowley RW, Liu KC. Evolution of endovascular mechanical thrombectomy for acute ischemic stroke. World J Clin Cases. 2014;2:614–22.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Chueh JY, Kühn AL, Puri AS, Wilson SD, Wakhloo AK, Gounis MJ. Reduction in distal emboli with proximal flow control during mechanical thrombectomy: a quantitative in vitro study. Stroke. 2013;44:1396–401.

    Article  PubMed  Google Scholar 

  14. Chueh J, Puri A, Wakhloo A, Gounis M. O-033 aspiration efficacy of suction catheter in the management of distal embolization during interventional treatment of acute ischemic stroke. J Neurointerv Surg. 2014;6:A18.

    Article  Google Scholar 

  15. Smith WS. Safety of mechanical thrombectomy and intravenous tissue plasminogen activator in acute ischemic stroke: results of the multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial, part I. AJNR Am J Neuroradiol. 2006;27:1177–82.

    CAS  PubMed  Google Scholar 

  16. Turk AS, Spiotta A, Frei D, Mocco J, Baxter B, Fiorella D, Siddiqui A, Mokin M, Dewan M, Woo H, Turner R, Hawk H, Miranpuri A, Chaudry I. Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg. 2014;6(3):231–7.

    Article  PubMed  Google Scholar 

  17. Kabbasch C, Möhlenbruch M, Stampfl S, Mpotsaris A, Behme D, Liebig T. First-line lesional aspiration in acute stroke thrombectomy using a novel intermediate catheter: initial experiences with the SOFIA. Interv Neuroradiol. 2016;22(3):333–9.

    Article  CAS  PubMed  Google Scholar 

  18. Faggioli GL, Ferri M, Rossi C, et al. Carotid stent failure: results of surgical rescue. Eur J Vasc Endovasc Surg. 2007;33:58–61.

    Article  CAS  PubMed  Google Scholar 

  19. Geuzebroek GS, Wille J, de Vries J-P, Schonewille W, Vos J-A. Trapped cerebral thrombectomy device: a case report of a rare complication. Vascular. 2015;23(2):179–82.

    Article  PubMed  Google Scholar 

  20. Binning MJ, Yashar P, Orion D, Hauck EF, Levy EI, Hopkins LN, et al. Use of the outreach distal access catheter for microcatheter stabilization during intracranial arteriovenous malformation embolization. AJNR Am J Neuroradiol. 2012;33:E117–9.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors thank Prof. Dr. Volker Müller-Benedict, Institut of Research Methods and Statistics, University of Flensburg, for support in statistical analyses.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology and Neuroradiology, Diakonissenhospital Flensburg, Knuthstraße 1, 24939, Flensburg, Germany

    S. Hopf-Jensen, M. Preiß, L. Marques, S. Lehrke & S. Müller-Hülsbeck

  2. Department of Neurology, Diakonissenhospital Flensburg, Flensburg, Germany

    J. Schattschneider & H. Stolze

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  1. S. Hopf-Jensen
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  2. M. Preiß
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  3. L. Marques
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  7. S. Müller-Hülsbeck
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Correspondence to S. Hopf-Jensen.

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Hopf-Jensen, S., Preiß, M., Marques, L. et al. Impact and Effectiveness of Dual Aspiration Technique in Stent-Assisted Mechanical Thrombectomy: Recent Improvements in Acute Stroke Management. Cardiovasc Intervent Radiol 39, 1620–1628 (2016). https://doi.org/10.1007/s00270-016-1404-4

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