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

Abstract

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.

2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment

“…The concomitant use of distal-access suction catheters during stent retriever mechanical thrombectomy has been described in retrospective case series. [32][33][34] The advantages of the combined stent-aspiration technique include a flexible large-bore catheter in a triaxial technique, which provides stability for the stent-retriever; flow reversal to prevent distal embolization during stent retrieval of the thrombus; and the potential synergistic effect of both techniques of suction aspiration and stent retrieval used simultaneously. 32,34 Clinical experience has shown the combination of balloon guide catheters or distal-access/aspiration catheters and stent retrievers to provide rapid, effective, and safe recanalization.…”

“…[32][33][34] The advantages of the combined stent-aspiration technique include a flexible large-bore catheter in a triaxial technique, which provides stability for the stent-retriever; flow reversal to prevent distal embolization during stent retrieval of the thrombus; and the potential synergistic effect of both techniques of suction aspiration and stent retrieval used simultaneously. 32,34 Clinical experience has shown the combination of balloon guide catheters or distal-access/aspiration catheters and stent retrievers to provide rapid, effective, and safe recanalization. 35,36 All the stent retriever trials allowed the inclusion of patients with proximal cervical carotid stenosis, and all but 1 trial allowed the inclusion of patients with complete atherosclerotic cervical carotid occlusion (SWIFT PRIME).…”

Comparison of Modern Stroke Thrombectomy Approaches Using an In Vitro Cerebrovascular Occlusion Model

“…1,2 Postmarketing experience indicates that in modern clinical practice, Stentrievers are often used in conjunction with another device such as an aspiration thrombectomy catheter or a balloon-guide catheter. [3][4][5] Moreover, direct aspiration thrombectomy by using recently developed large-bore aspiration catheters has shown promise as an effective alternative approach for intra-arterial revascularization. 6,7 However, the recanalization effectiveness of these types of thrombectomy devices has not been compared in a randomized trial, to our knowledge.…”

Comparison of Vacuum Pressures and Forces Generated by Different Catheters and Pumps for Aspiration Thrombectomy in Acute Ischemic Stroke

“…Finally, some users advocate a combined technique using a stent retriever and an aspiration catheter for thrombectomy in stroke [17,18]. When using such a coaxial approach, the stent retriever delivery microcatheter may partially occlude the aspiration catheter and thereby potentially reduce the vacuum force.…”