Abstract
BackgroundMechanical 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.MethodsWe 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).ResultsMedian 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.ConclusionMechanical thrombectomy of posterior large vessel occlusions with SAVE is feasible, safe, and effective with high rates of near-complete and complete reperfusion.
Highlights
Mechanical thrombectomy (MT) using stent retriever assisted vacuum-locked extraction (SAVE) is a promising method for anterior circulation strokes
Mechanical thrombectomy (MT) is the standard treatment for patients suffering from acute ischemic stroke (AIS) due to intracranial large vessel occlusion (LVO) in the anterior circulation since large randomized controlled trials (RCT) showed efficacy of this strategy over standard medical care [1]
We present our experience with the recently introduced stent retriever assisted vacuum-locked extraction (SAVE) technique in the posterior circulation
Summary
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. Mechanical thrombectomy (MT) is the standard treatment for patients suffering from acute ischemic stroke (AIS) due to intracranial large vessel occlusion (LVO) in the anterior circulation since large randomized controlled trials (RCT) showed efficacy of this strategy over standard medical care [1]. 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]. We present our experience with the recently introduced stent retriever assisted vacuum-locked extraction (SAVE) technique in the posterior circulation
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