Manual Aspiration Thrombectomy

Abstract

Background and Purpose-We evaluated recanalization rates, clinical outcomes, and safety when manual aspiration thrombectomy is used in conjunction with other thrombolytic modalities in a consecutive case series of patients with large vessel intracranial occlusion. Methods-We conducted a retrospective review of a prospectively acquired acute endovascular stroke database. Manual aspiration thrombectomy was carried out with Distal Access and Penumbra reperfusion catheters of different sizes placed in the thrombus and aspirated with a syringe. Results-We identified 191 patients: Occlusion locations were as follows: M1% to 50%, M2% to 10%, internal carotid artery terminus 25%, and vertebrobasilar 15%. Median treatment duration was 90 minutes. Recanalization results were Thrombolysis in Myocardial Ischemia 2/3 93%, Thrombolysis in Myocardial Ischemia 3 27%, Thrombolysis In Cerebral Infarction 2a/2b/3 91%, Thrombolysis In Cerebral Infarction 2b/3 71%, and Thrombolysis In Cerebral Infarction 3 25%. Larger catheters were associated with higher recanalization rates. Parenchymal hematoma rate was 13.6%. The favorable outcome (90-day modified Rankin Scale Յ2) rate was 54%. Mortality at 90 days was 25%. Conclusions-Manual aspiration thrombectomy is a useful addition to the armamentarium of endovascular treatment modalities for acute stroke.

Switching Strategy for Mechanical Thrombectomy of Acute Large Vessel Occlusion in the Anterior Circulation

“…1 For example, thrombus aspiration and proximal thrombectomy (FAST in this article) is technically simple, fast to apply, and inexpensive. 1,2,4 In terms of stent retrievers such as Solitaire FR and Trevo (Stryker, Mountain view, CA), several benefits include immediate revascularization after stent deployment, easy advancement, and a high recanalization rate. 3,5 During period 1, we experienced cases of difficult recanalization or failure using only FAST; therefore, we switched techniques in difficult cases during period 2 under the hypothesis that additional attempts of MT with a different mechanism (Solitaire) could improve recanalization.…”

“…Third, our study solely used 0.041-or 0.054-in Penumbra aspiration catheters (Penumbra, Alameda, CA) during FAST; thus, different outcomes may have resulted, if larger catheters were applied. 4 Finally, this study only contains switching techniques from FAST to Solitaire thrombectomy, and the data should be interpreted cautiously because different types of switching may result in different outcomes.…”

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

“…Furthermore, there are now several options for aspiration pumps. While the Penumbra system has offered an electrical pump since its inception [13], many interventionalists have opted for manual aspiration with a large syringe [14,15]. There is also the relatively new ASPIRE aspiration pump that has been used for peripheral thrombectomy [16] and consists of a handle-actuated, modified syringe with valves to allow for continuous vacuum generation while purging aspirated blood.…”

Stent Retriever-Mediated Manual Aspiration Thrombectomy for Acute Ischemic Stroke

“…While superior to previous mechanical or pharmacological approaches, prospective case series revealed that with effective reperfusion rates in the 68-69% range, the need for multiple passes to achieve recanalization and the incidence of embolization in previously uninvolved territory (ENT), stent retriever embolectomy can be further improved. Aspiration thrombectomy performed either manually [5,6] or in conjunction with a pump [7] has been described as a therapeutic option with signals of benefit over intravenous rtPA as a stand-alone treatment in a recently conducted randomized trial [8], although the therapeutic effect seems lower with this technology compared with stent retrievers. We have previously reported on the role of manual aspiration thrombectomy (MAT) as an adjunctive therapy [5] or as a primary first-pass technique [6] in large-vessel occlusion.…”

“…Aspiration thrombectomy performed either manually [5,6] or in conjunction with a pump [7] has been described as a therapeutic option with signals of benefit over intravenous rtPA as a stand-alone treatment in a recently conducted randomized trial [8], although the therapeutic effect seems lower with this technology compared with stent retrievers. We have previously reported on the role of manual aspiration thrombectomy (MAT) as an adjunctive therapy [5] or as a primary first-pass technique [6] in large-vessel occlusion. Despite a high rate of effective reperfusion observed with primary MAT, in light of the high rates and quality of recanalization observed with stent retriever technology, we modified our manual aspiration technique to include an initial step of stent retriever deployment followed by aspiration.…”