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Original Paper

Free Access

Stent Retriever-Mediated Manual Aspiration Thrombectomy for Acute Ischemic Stroke

Jadhav A.P.a, b · Aghaebrahim A.a · Horev A.d · Giurgiutiu D.-V.c · Ducruet A.F.b · Jankowitz B.b · Jovin T.G.a, b

Author affiliations

Departments of aNeurology and bNeurological Surgery, UPMC Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa. and cWinchester Neurological Consultants, Winchester, Va., USA; dSoroka Medical Center, Beersheba, Israel

Corresponding Author

Ashutosh P. Jadhav, MD

Stroke Institute, University of Pittsburgh

200 Lothrop Street, Suite C-400

Pittsburgh, PA 15213 (USA)

E-Mail jadhavap@upmc.edu

Related Articles for ""

Intervent Neurol 2017;6:16-24

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Background and Purpose: Stent retriever thrombectomy and manual aspiration thrombectomy (MAT) have each been shown to lead to high rates of recanalization as single-modality endovascular stroke therapy. We sought to describe the safety and efficacy of a multimodal approach combining these two techniques termed ‘stent retriever-mediated manual aspiration thrombectomy' (SMAT) and compared them to MAT alone. Methods: Retrospective review of a prospectively acquired acute endovascular stroke database. Results: 195 consecutive patients with large-vessel occlusion were identified between July 2013 and April 2015. Occlusion distribution was as follows: 52% middle cerebral artery segment 1 (M1), 6% M2, 29% internal carotid artery, and 13% vertebrobasilar. Median onset to treatment time was 278 min. Intravenous rtPA was administered in 33% of cases, whereas 34% of cases had symptom onset beyond 8 h. Effective recanalization (TICI 2b/3) was achieved in 91% of patients and in 49% of patients, only a single pass was necessary. Median groin puncture to recanalization time was 40 min. Symptomatic intracerebral hemorrhage occurred in 5% of patients. Favorable outcomes defined as a modified Rankin Scale score of 0-2 were noted in 42% of patients. Compared with MAT alone, SMAT achieved a similar rate of effective recanalization (91 vs. 88%, p = n.s.) but was associated with faster access to reperfusion times (49 vs. 77 min, p < 0.00001). Conclusions: SMAT is a safe and efficacious method to achieve rapid revascularization that leads to faster recanalization compared to manual aspiration alone. Future prospective comparisons are necessary to establish the most clinically effective therapy for acute thrombectomy.

© 2016 S. Karger AG, Basel


  1. Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, et al: Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke 2003;34:e109-e137.
  2. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al: A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11-20.
  3. Saver JL, Goyal M, Diener HC, Investigators SP: Stent-retriever thrombectomy for stroke. N Engl J Med 2015;373:1077.
  4. Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD, et al: Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 2013;368:893-903.
  5. Jankowitz B, Grandhi R, Horev A, Aghaebrahim A, Jadhav A, Linares G, et al: Primary manual aspiration thrombectomy (MAT) for acute ischemic stroke: safety, feasibility and outcomes in 112 consecutive patients. J Neurointerv Surg 2015;7:27-31.
  6. Jankowitz B, Aghaebrahim A, Zirra A, Spataru O, Zaidi S, Jumaa M, et al: Manual aspiration thrombectomy: adjunctive endovascular recanalization technique in acute stroke interventions. Stroke 2012;43:1408-1411.
  7. Turk AS, Spiotta A, Frei D, Mocco J, Baxter B, Fiorella D, et al: Initial clinical experience with the adapt technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg 2014;6:231-237.
  8. Mocco J, Khatri P, Zaidat O: The randomized, concurrent controlled trial to assess the penumbra system's safety and effectiveness in the treatment of acute stroke. European Stroke Organisation (ESO) Conference, Glasgow, 2015.
  9. Barber PA, Demchuk AM, Zhang J, Buchan AM: Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 2000;355:1670-1674.
  10. Berger C, Fiorelli M, Steiner T, Schabitz WR, Bozzao L, Bluhmki E, et al: Hemorrhagic transformation of ischemic brain tissue: asymptomatic or symptomatic? Stroke 2001;32:1330-1335.
  11. Khatri P, Yeatts SD, Mazighi M, Broderick JP, Liebeskind DS, Demchuk AM, et al: Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke: an analysis of data from the Interventional Management of Stroke (IMS III) phase 3 trial. Lancet Neurol 2014;13:567-574.
  12. Sheth SA, Jahan R, Gralla J, Pereira VM, Nogueira RG, Levy EI, et al: Time to endovascular reperfusion and degree of disability in acute stroke. Ann Neurol 2015;78:584-593.
  13. Patel RD, Saver JL: Evolution of reperfusion therapies for acute brain and acute myocardial ischemia: a systematic, comparative analysis. Stroke 2013;44:94-98.
  14. Nogueira RG, Lutsep HL, Gupta R, Jovin TG, Albers GW, Walker GA, et al: Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet 2012;380:1231-1240.
  15. Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, et al: Solitaire flow restoration device versus the merci retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet 2012;380:1241-1249.
  16. Pereira VM, Gralla J, Davalos A, Bonafe A, Castano C, Chapot R, et al: Prospective, multicenter, single-arm study of mechanical thrombectomy using solitaire flow restoration in acute ischemic stroke. Stroke 2013;44:2802-2807.
  17. Zaidat OO, Castonguay AC, Gupta R, Sun CH, Martin C, Holloway WE, et al: North American Solitaire Stent Retriever Acute Stroke Registry: post-marketing revascularization and clinical outcome results. J Neurointerv Surg 2014;6:584-588.
  18. Nguyen TN, Malisch T, Castonguay AC, Gupta R, Sun CH, Martin CO, et al: Balloon guide catheter improves revascularization and clinical outcomes with the solitaire device: analysis of the North American Solitaire Acute Stroke Registry. Stroke 2014;45:141-145.
  19. Kirtane AJ, Stone GW: The Anchor-Tornus technique: a novel approach to ‘uncrossable' chronic total occlusions. Catheter Cardiovasc Interv 2007;70:554-557.
  20. Humphries W, Hoit D, Doss VT, Elijovich L, Frei D, Loy D, et al: Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke. J Neurointerv Surg 2015;7:90-94.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Published online: October 07, 2016
Issue release date: March 2017

Number of Print Pages: 9
Number of Figures: 1
Number of Tables: 5

ISSN: 1664-9737 (Print)
eISSN: 1664-5545 (Online)

For additional information: https://www.karger.com/INE

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