Clot Aspiration Thrombectomy in Acute Ischemic Stroke

Abstract

The first approved treatment for acute ischemic stroke was intravenous recombinant tissue plasminogen activator; however, the efficacy was limited as a result of its narrow time window for administration, certain contraindications, and low recanalization rates. This prompted an evolution in endovascular stroke therapy during the past two decades, moving from intra-arterial thrombolytic infusion to modern mechanical thrombectomy techniques. Among the various endovascular approaches, stent retriever thrombectomy and direct clot aspiration are two dominant methods in the present era. One such mechanical thrombectomy technique, “clot aspiration thrombectomy” or “direct clot aspiration,” is the topic of this chapter. The commonalities and differences between the current two major techniques for clot aspiration thrombectomy, a direct aspiration first pass technique (ADAPT) and forced arterial suction thrombectomy (FAST), will be explained. And the details regarding the combined usage of direct clot aspiration and stent retriever thrombectomy, namely, the switching strategy and the Solumbra technique, will be additionally discussed.