Abstract TP18: Recanalization in Acute Stroke Interventions with Manual Aspiration Thrombectomy as a Stand Alone Technique

Abstract

Background and Purpose: Manual aspiration thrombectomy (MAT) represents an alternative means to open occluded intracranial vessels. The technique involves advancing a large bore catheter into the thrombus and manually aspirating through a syringe. We have previously reported our experience with nearly 200 patients, however most cases involved the use of an adjunctive device such as the MERCI retriever to facilitate clot disruption or advancement of the catheter through the tortuous carotid siphon. This selected case series represents those patients treated with MAT alone. Methods: The University of Pittsburgh acute stroke database was retrospectively reviewed to evaluate those patients presenting with a large vessel intracranial occlusion who were treated with MAT. The decision to treat was based on the amount of brain still considered at risk based on CT, CTP, or MRI, and not on time from onset. Patients were excluded if an adjunctive device was used to facilitate catheter advancement or clot disruption/removal. These devices included the MERCI retriever, Penumbra aspiration system, Solitaire, TREVO, stent, or balloon. Intra-arterial thrombolytics or antiplatelets were allowed. Results: Forty-seven patients met the inclusion criteria. The mean/median NIHSS was 17/16. The mean/median time from last seen normal to groin puncture was 8.3/6.5 hours. The mean/median time from groin puncture to recanalization was 50/40 minutes. The target vessel was the basilar, M1, and ICA-terminus in 7, 30, and 10 patients respectively. The mean/median number of aspiration attempts was 1.7/1. All patients achieved at least TIMI 2 recanalization, owing to the fact that failure to achieve this result prompted the use of an adjunctive device. 42/47 patients achieved TICI 2B/3 recanalization. Conclusions: Pure MAT without the use of an adjunctive device represents another method to achieve intracranial recanalization with the potential for significant cost savings. Safety and outcomes must still be evaluated.