Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke.

Humphries, William; Hoit, Daniel; Doss, Vinodh T; Elijovich, Lucas; Frei, Donald; Loy, David; Dooley, Gwen; Turk, Aquilla S; Chaudry, Imran; Turner, Raymond; Mocco, J; Morone, Peter; Fiorella, David; Siddiqui, Adnan; Mokin, Maxim; Arthur, Adam S

OBJECTIVE Flexible large lumen aspiration catheters and stent retrievers have recently become available in the USA for the revascularization of large vessel occlusions presenting within the context of acute ischemic stroke (AIS). We describe a multicenter experience using a combined aspiration and stent retrieval technique for thrombectomy. DESIGN A retrospective analysis to identify patients receiving combined manual aspiration and stent retrieval for treatment of AIS between August 2012 and April 2013 at six high volume stroke centers was conducted. Outcome variables, including recanalization rate, post-treatment National Institutes of Health Stroke Scale (NIHSS) score, symptomatic intracranial hemorrhage, discharge 90 day modified Rankin Scale (mRS) score, and mortality were evaluated. RESULTS 105 patients were found that met the inclusion criteria for this retrospective study. Successful recanalization (Thrombolysis in Cerebral Infarction score 2B) was achieved in 92 (88%) of these patients. 44% of patients had favorable (mRS score 0-2) outcomes at 90 days. There were five (4.8%) symptomatic intracerebral hemorrhages and three procedure related deaths (2.9%). CONCLUSIONS Mechanical thrombectomy utilizing combined manual aspiration with a stent retriever is an effective and safe strategy for endovascular recanalization of large vessel occlusions presenting within the context of AIS.