Series of fast reperfusion with simultaneous proximal and distal aspiration in patients with acute ischemic stroke

Abstract

Abstract Background Various endovascular techniques for the recanalization of large vessel occlusion in patients with acute ischemic stroke have been established. In this series a combined distal and proximal aspiration technique was used as a novel approach. The aim of this study was to investigate, whether this technique achieves reperfusion faster and if embolization in distal territories can be reduced. Results The success of the treatment was dependent on the localization of the clot. Fast reperfusion was achieved in all patients when the clot was located at the level of the middle cerebral artery. Aspiration failed when the vessel occlusion was located at the level of the carotid-T and subsequent rescue treatment was performed. Median groin puncture to reperfusion time was 20 min (range 9–66). No Embolization to new territories (ENT) and no intracerebral hemorrhage were observed. One patient died. In all other patients favorable neurological outcome was observed as measured by a modified Rankin score at discharge (mRS 0, range 0–1). Conclusion Simultaneous proximal and distal aspiration appears to be fast and effective. Furthermore, it reliably prevented ENT in patients with vessel occlusion at the level of the middle cerebral artery in a small cohort.

Keywords

• Stroke
• Anterior circulation
• Mechanical thrombectomy
• Distal aspiration
• Proximal aspiration
• Balloon guide catheter