The Source for Neurovascular News and Education

March 28, 2024

 

Key Points:

- Study assesses stent retriever thrombectomy with, without intracranial aspiration

- Mean number of passes, time from arteriotomy to recanalization reduced with aspiration


Combining use of both a stent retriever and an intracranial aspiration catheter to achieve revascularization after large vessel occlusion can speed the time to recanalization and reduce the number of passes needed, according to a retrospective analysis published online September 1, 2016, ahead of print in the Journal of NeuroInterventional Surgery.

Gaurav Jindal, MD, of the University of Maryland Medical (Baltimore, MD), and colleagues reviewed data on 97 patients treated with a stent retriever at a single institution for anterior circulation stroke. Among these patients, 68 also received intracranial aspiration.

Patients who were treated with intracranial aspiration were older than those treated without (mean age 66 vs 59 years, P = .008). The two groups were similar, however, with regard to mean presenting NIHSS score (18.7 vs 18.2, P = .50).

Rates of sucessful recanalization, defined as TICI 2b-3, and postprocedural subarachnoid hemorrhage were similar for both groups of patients. Yet the time from groin arteriotomy to recanalization (excluding TICI 0-1 patients) was significantly longer for patients not given intracranial aspiration. Those receiving stent retriever alone also tended to require a greater number of device passes (table 1).

Table 1. Outcomes of Stent Retriever Therapy Based on Intracranial Aspiration Use

 

With

(n = 68)

Without

(n = 29)

P Value

Number of Device Passes

1.9 ± 0.1

2.5 ± 0.6

.009

Successful Recanalization

85%

90%

.41

Time from Arteriotomy To Recanalization (min)

50 ± 3.6

61 ± 6.6

.049

Postprocedural Subarachnoid Hemorrhage

15%

19%

.41

 

Balancing Risks and Benefits

According to Perry Ng, MD, of Centura Health Physician Group (Denver, CO), use of intracranial aspiration depends largely on operator preference, with interventionalists working at smaller hospitals less likely to be comfortable with the complexity of using both devices than fellowship-trained neurointerventionists.

Each of the devices has “been shown to be highly effective in clot retrieval, with recanalization rates of > 80%-90% being reported,” he told Neurovascular Exchange in an email. “A combination of the two techniques would theoretically allow one to engage and trap the thrombus within the tines of a [stent retriever] to reduce loss or fragmentation of the thrombus during clot retrieval with simultaneous aspiration of the clot face using an [intracranial aspiration catheter]. This seems to be borne out by this study.”

Dr. Ng also pointed out, however, that while this study did not reveal any additional complications with using both devices together, it does “entail additional intracranial guidewire navigation and superselective microcatheterization of pial arteries, which can result in vessel dissection, vasospasm, perforation, and clot fragmentation.

“There is also a higher risk of iatrogenic thromboembolism . . . due to the use of additional microcatheters and associated pressurized flush bags,” he added.

Given these potential issues, Dr. Ng believes that the combination should be reserved for patients with large vessel occlusions that have nontortuous vascular anatomy enroute to the clot, those with a prolonged time since stroke onset (or tenuous collateral circulation on perfusion imaging), or those who have failed treatment using a stent retriever or intracranial aspirator alone. In such patients, this study suggests, the risks of going through a more complex procedure that involves higher costs are likely outweighed by the potential benefits.

 


Source:

Jindal G, Serulle Y, Miller T, et al. Stent retrieval thrombectomy in acute stoke is facilitated by the concurrent use of intracranial aspiration catheters. J NeuroIntervent Surg. 2016;Epub ahead of print.

Disclosures:

- Dr. Jindal reports receiving research related grants funded by Stryker Neurovascular, Medtronic, Microvention, and Codman Neurovascular

- Dr. Ng reports no relevant conflicts of interest