Journal Article

Clot reduction prior to embolectomy: mSAVE as a first-line technique for large clots

McTaggart, Ryan, Goyal, Mayank, Tsogkas, Ioannis, Hesse, Amelie, Maus, Volker, Maier, Ilko, Behme, Daniel, Psychogios, Marios-Nikos, Schnieder, Marlena, Brehm, Alex

2019

Overview

The \"Stent retriever Assisted Vacuum-locked Extraction\" (SAVE) technique is a promising embolectomy method for intracranial large vessel occlusion (LVO). We report our experience using a modified SAVE (mSAVE) approach for clot reduction prior to embolectomy in acute ischemic stroke patients with large clots. We retrospectively analyzed 20 consecutive patients undergoing mSAVE in our center due to intracranial LVO. Angiographic data (including first-pass and overall complete reperfusion, defined as an expanded Thrombolysis in Cerebral Infarction (eTICI) score of 3, rate of successful reperfusion (eTICI ≥2c), number of passes, time from groin puncture to reperfusion) and clinical data (favorable outcome at 90 days, defined as modified Rankin Scale (mRS) ≤2) were assessed. First-pass and overall eTICI 3 reperfusion was reached in 13/20 (65%) and 14/20 (70%), respectively. The rate of successful reperfusion (eTICI ≥2c) after one pass was 85% and on final angiogram 90% with an average number of 1.1 ± 0.3 attempts. Eight out of 11 (73%) ICA occlusions were reperfused successfully and 5 (46%) completely after a single pass. Median groin to reperfusion time was 33 minutes (IQR 25-46). A favorable clinical outcome was achieved in 9/20 (45%) patients at discharge and after 90 days, respectively. Clot reduction followed by embolectomy (mSAVE) is feasible and may be an important tool in the treatment of large clots.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Aged / Aged, 80 and over / Analysis / Biology and Life Sciences / Blood clots / Blood vessels / Brain Ischemia - diagnostic imaging / Brain Ischemia - surgery / Care and treatment / Carotid arteries / Catheters / Cerebral Angiography / Cerebral blood flow / Cerebral infarction / Clinical outcomes / Clinical trials / Embolectomy / Embolectomy - methods / Endovascular Procedures - methods / Engineering and Technology / Female / Humans / Implants / Infarction / Ischemia / Male / Medical imaging / Medicine and Health Sciences / Nuclear medicine / Occlusion / Occlusions / Patient outcomes / Patients / Reduction / Reperfusion / Research and Analysis Methods / Retrospective Studies / Risk factors / Stents / Stroke / Stroke - diagnostic imaging / Stroke - surgery / Stroke patients / Success / Surgical implants / Thrombectomy - methods / Thrombolysis / Vacuum / Veins & arteries