The SAVE Technique

Maus, Volker; Henkel, Silja; Riabikin, Alexander; Riedel, Christian; Behme, Daniel; Tsogkas, Ioannis; Hesse, Amélie Carolina; Abdullayev, Nuran; Jansen, Olav; Wiesmann, Martin; Mpotsaris, Anastasios; Psychogios, Marios‐Nikos

doi:10.1007/s00062-018-0702-4

“…The multi-center ENDOSTROKE registry showed at least that the use of stent retriever is an independent predictor of recanalization in the posterior circulation, however, recanalization itself did not predict clinical outcome in this study [7]. In our study, we analyzed the performance of the SAVE technique based on our experience with this method for the anterior circulation [11]. Similar to our previous results, we observed SAVE to be an effective and safe thrombectomy method in patients suffering from LVO in the posterior circulation.…”

Section: Discussionmentioning

confidence: 97%

“…The SAVE technique has been recently described [11]. Briefly, based on a triaxial approach, access to cerebral vasculature is obtained either with a 6 or 7 French (F) guide catheter (Envoy, Cordis, Fremont, CA, USA; Mach 1, Boston Scientific, Marlborough, MA, USA).…”

Section: Thrombectomy Technique With Savementioning

confidence: 99%

“…The main methods of MT for LVO include stent retriever thrombectomy with or without the use of an aspiration catheter [9] or the use of a large-bore distal access catheter alone (known as "A Direct Aspiration first Pass Technique", ADAPT) [10]. Among the combined approaches, new techniques were developed, which differ in stent retriever placement in relation to the clot, time of aspiration and/or proximal use of balloon guide catheters with promising reperfusion results in the anterior circulation [11][12][13]. In this study, we present our experience with the recently introduced stent retriever assisted vacuum-locked extraction (SAVE) technique in the posterior circulation.…”

mentioning

confidence: 99%

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Intracranial mechanical thrombectomy of large vessel occlusions in the posterior circulation using SAVE

Maus¹,

Styczen

²

,

Liman

³

et al. 2019

Preprint

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0

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Background Mechanical thrombectomy (MT) using stent retriever assisted vacuum-locked extraction (SAVE) is a promising method for anterior circulation strokes. We present our experience with SAVE for large vessel occlusions (LVO) of the posterior circulation. Methods We retrospectively analyzed 66 consecutive MT patients suffering from LVO of the posterior circulation. Primary endpoints were first-pass and overall complete/near complete reperfusion, defined as a modified thrombolysis in cerebral infarction (mTICI) score of 2c and 3. Secondary endpoints contained number of passes, time interval from groin puncture to reperfusion and rate of postinterventional symptomatic intracranial hemorrhage (sICH). Results Median age was 75 years (interquartile range (IQR) 54 – 81 years). Baseline median National Institutes of Health stroke scale (NIHSS) was 13 (IQR 8 – 21). Fifty-five (83%) patients had LVO of the basilar artery and 11 (17%) of the posterior cerebral artery. Eighteen (27%) patients were treated with SAVE and 21 (32%) with aspiration only. First pass mTICI2c or 3 and overall mTICI2c or 3 were documented in 11/18 (61%) and 14/18 (78%) with SAVE and in 4/21 (19%) and 13/21 (33%) with aspiration only. Median attempt was 1 (IQR 1 – 2) with SAVE and 2 (IQR 1 – 4) with aspiration (p=0.0249). Median groin to reperfusion time did not differ significantly between groups. The rate of sICH was 5% without any complications in the SAVE cohort. Conclusion Mechanical thrombectomy of posterior large vessel occlusions with SAVE is feasible, safe, and effective with high rates of near-complete and complete reperfusion.

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“…The stentriever assisted vacuum-locked extraction technique is a variation of the technique used in our practice. With stentrieverassisted vacuum-locked extraction, the stentriever is placed distally such that only the proximal third of the stent covers the occlusion and the aspiration is advanced after the stentriever has been deployed and is "wedged" up against the clot to aid in clot capture [27]. Finally, the use of a stentriever under constant manual aspiration with a 60-mL syringe through a balloon guide catheter has been used, but this technique had DCM rates that are similar to A Direct Aspiration First Pass Technique (6.8 vs. 5.7%) [28].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Distal Clot Migration during Mechanical Thrombectomy of Anterior Circulation Large Vessel Occlusion

Mohammaden

¹

,

Stapleton

²

,

Brunozzi

³

et al. 2020

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Introduction: Distal clot migration (DCM) is a known complication of mechanical thrombectomy (MT), but neither risk factors for DCM nor ways of how it might affect clinical outcomes have been extensively studied to date. Methods: To identify risk factors for and outcomes in the setting of DCM, the records of all patients with acute ischemic stroke due to anterior circulation large vessel occlusion (LVO) treated with MT at a single center between May 2016 and June 2018 were retrospectively reviewed. Uni-and multivariable analyses were performed to evaluate predictors of DCM and good functional outcome (90-day modified Rankin Scale; mRS 0-2). Results: A total of 65 patients were included, DCM was identified in 22 patients (33.8%). Patients with DCM had significantly higher pre-procedural intravenous tissue plasminogen activator (IV-tPA) administration (81.8 vs. 53.5%, p = 0.03), stentrievers thrombectomy (95.5 vs. 62.8%, p = 0.006), and longer median puncture to recanalization time (44 [34-97] vs. 30 [20-56] min, p = 0.028) as compared to group with non-DCM. Also, they had lower rates of Thrombolysis in Ce-rebral Infarction (TICI) 2b/3 recanalization (p = 0.002), higher median National Institutes of Health Stroke Scale (NIHSS) scores at discharge (p = 0.01), and lower rates of 90-day mRS (0-2; 18.2 vs. 48.8%; p = 0.016). On subgroup analysis, patients with middle cerebral artery occlusions who underwent MT with stentrievers < 40 mm in length had a higher risk of DCM (p = 0.026). On multivariable analysis, IV-tPA administration (OR; 5.019, 95% CI [1. .102], p = 0.018) and stentrievers thrombectomy (OR; 10.031, 95% CI [1. 090-92.344]; p = 0.04) remained significant predictors of DCM. Baseline NIHSS score (OR; 0.872, 95% CI [0.788-0.965], p = 0.008) and DCM (OR; 0.250, 95% CI [0.075-0.866], p = 0.03) were independent predictors of 90-day mRS 0-2. Conclusion: In patients undergoing MT for anterior circulation LVO, DCM is associated with lower rates of TICI 2b/3 recanalization and worse functional outcomes at 90 days. IV-tPA administration and MT with short stentrievers are independent predictors of DCM development.

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“…The main methods of MT for LVO include stent retriever thrombectomy with or without the use of an aspiration catheter [9] or the use of a large-bore distal access catheter alone (known as "A Direct Aspiration first Pass Technique", ADAPT) [10]. Among the combined approaches, new techniques were developed, which differ in stent retriever placement in relation to the clot, time of aspiration and/or proximal use of balloon guide catheters with promising reperfusion results in the anterior circulation [11][12][13]. In this study, we present our experience with the recently introduced stent retriever assisted vacuum-locked extraction (SAVE) technique in the posterior circulation.…”

Section: Introductionmentioning

confidence: 99%

Intracranial mechanical thrombectomy of large vessel occlusions in the posterior circulation using SAVE

Maus¹,

Styczen

²

,

Liman

³

et al. 2019

Preprint

Self Cite

0

View full text Add to dashboard Cite

Background Mechanical thrombectomy (MT) using stent retriever assisted vacuum-locked extraction (SAVE) is a promising method for anterior circulation strokes. We present our experience with SAVE for large vessel occlusions (LVO) of the posterior circulation. Methods We retrospectively analyzed 66 consecutive MT patients suffering from LVO of the posterior circulation. Primary endpoints were first-pass and overall complete/near complete reperfusion, defined as a modified thrombolysis in cerebral infarction (mTICI) score of 2c and 3. Secondary endpoints contained number of passes, time interval from groin puncture to reperfusion and rate of postinterventional symptomatic intracranial hemorrhage (sICH). Results Median age was 75 years (interquartile range (IQR) 54 – 81 years). Baseline median National Institutes of Health stroke scale (NIHSS) was 13 (IQR 8 – 21). Fifty-five (83%) patients had LVO of the basilar artery and 11 (17%) of the posterior cerebral artery. Eighteen (27%) patients were treated with SAVE and 21 (32%) with aspiration only. First pass mTICI2c or 3 and overall mTICI2c or 3 were documented in 11/18 (61%) and 14/18 (78%) with SAVE and in 4/21 (19%) and 13/21 (33%) with aspiration only. Median attempt was 1 (IQR 1 – 2) with SAVE and 2 (IQR 1 – 4) with aspiration (p=0.0249). Median groin to reperfusion time did not differ significantly between groups. The rate of sICH was 5% without any complications in the SAVE cohort. Conclusion Mechanical thrombectomy of posterior large vessel occlusions with SAVE is feasible, safe, and effective with high rates of near-complete and complete reperfusion.

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The SAVE Technique

Abstract: Mechanical thrombectomy using the SAVE technique seems to be effective, fast and safe. First-line use of SAVE leads to high rates of complete and near complete reperfusion.

Cited by 66 publications

References 34 publications

Intracranial mechanical thrombectomy of large vessel occlusions in the posterior circulation using SAVE

Intracranial mechanical thrombectomy of large vessel occlusions in the posterior circulation using SAVE

Risk Factors for Distal Clot Migration during Mechanical Thrombectomy of Anterior Circulation Large Vessel Occlusion

Intracranial mechanical thrombectomy of large vessel occlusions in the posterior circulation using SAVE

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