Maximizing First-Pass Complete Reperfusion with SAVE.

Abstract

Endovascular techniques for treatment of large vessel occlusions (LVO) in patients with acute ischemic stroke (AIS) have advanced in recent years. We report amulticenter experience using acombined aspiration and stent retriever technique for mechanical thrombectomy (MT). We retrospectively analyzed 32 consecutive MT patients using anovel, combined approach of Stent retriever Assisted Vacuum-locked Extraction (SAVE) by 3operators at 3stroke centers. Primary endpoint was successful first-pass reperfusion with a modified Thrombolysis in Cerebral Infarction (mTICI) score of 3. Secondary endpoints were number of passes, time from groin puncture to reperfusion, embolization to new territories (ENT), postinterventional symptomatic intracranial hemorrhage (sICH) and clinical outcome at discharge. First-pass mTICI3 reperfusion was achieved in 23 out of 32patients (72%) with amean groin puncture to reperfusion time of 36.0 min± 15.8 and mTICI3 was accomplished in 25 out of 32cases (78%) with amaximum of 3attempts. Successful reperfusion (mTICI≥ 2b) was achieved in all patients (100%) with amean time from groin puncture to reperfusion of 44.5 min± 25.8 and an average of 1.2± 0.7attempts. The rate of ENT was 0% and 1 patient with sICH after MT died on postoperative day 4. At discharge, the median National Institutes of Health Stroke Scale (NIHSS) score was 4 (range 0-17) and favorable neurological outcome by the modified Rankin score (mRS≤ 2) was achieved in 19 out of 32patients (59%). SAVE is fast and appears to be very effective in terms of first-pass complete reperfusion in patients with LVO.