ARTS (Aspiration–Retriever Technique for Stroke): Initial clinical experience

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> A new generation of highly navigable large-bore aspiration catheters and retriever devices for intracranial mechanical thrombectomy has markedly improved recanalization rates, time and clinical outcomes. We report collected clinical data utilizing a new technique based on combined large lumen aspiration catheter and partially resheathed stent retriever (ARTS: Aspiration (catheter)–(stent) Retriever Technique for Stroke). This technique is applied, especially in presence of bulky/rubbery emboli, when resistance is felt while retracting the stent retriever; at that point the entire assembly is locked and removed in-toto under continuous aspiration with additional flow arrest. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A retrospective data analysis was performed to identify patients with large cerebral artery acute ischemic stroke treated with ARTS. The study was conducted between August 2013 and February 2015 at a single high volume stroke center. Procedural and clinical data were captured for analysis. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Forty-two patients (median age 66 years) met inclusion criteria for this study. The ARTS was successful in achieving Thrombolysis in Cerebral Infarction (TICI) ≥2b revascularization in 97.6% of cases (TICI 2b = 18 patients, TICI 3 = 23 patients). Patients’ median National Institutes of Health Stroke Scale score at admission was 18 (6–40). A 3-month follow-up modified Rankin Scale value of 0–2 was achieved in 65.7% of the successfully treated patients (average 2.4). Two patients (4.8%) developed symptomatic intraparenchymal hemorrhages. Six procedure unrelated deaths were observed. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> We found that ARTS is a fast, safe and effective method for endovascular recanalization of large vessel occlusions presenting within the context of acute ischemic stroke. </jats:p></jats:sec>

Under Pressure: Comparison of Aspiration Techniques for Endovascular Mechanical Thrombectomy

“…technique, and so forth) and generating backward flow to prevent clot embolization. 3,6,11 The force at the catheter tip depends on only the catheter diameter and the applied pressure and is therefore not altered by resistors. 12 The flow, however, is highly influenced by additional resistors; thus, any additional tubing and valves should be avoided whenever a backward flow is desired.…”

“…1 In past years, the focus of neurointerventional stroke research has shifted from establishing the method to finding the optimal treatment technique. [2][3][4][5][6] Effective blood flow management during the procedure is key to safety and effectiveness. 7 Chueh et al 2 have shown that there are thousands of small clot fragments during thrombectomy that may occlude small arterioles and capillaries.…”

Stent retrieval thrombectomy in acute stoke is facilitated by the concurrent use of intracranial aspiration catheters

“…There are also single-arm series on the use of an IAC alone without an SR which suggest that this technique may be as efficacious or even more efficacious than using an SR 3 4 9–11. There are also single-arm series on the SR/IAC combination approach 12. Still others have compared use of balloon guide catheters versus non-balloon guide catheters with SRs 13.…”

Development of a recalcitrant, large clot burden, bifurcation occlusion model for mechanical thrombectomy

“…Further experiments will help to validate and confirm the recalcitrance of our bifurcation model. This includes the evaluation of different established modalities for thrombectomy, such as the ADAPT (A Direct Aspiration First Pass Technique) 17 and ARTS (Aspiration-Retriever Technique for Stroke) 12 methods, or primary suction thrombectomy (Fig. 4).…”