Background and Purpose:
MAT is increasingly recognized as a valuable endovascular treatment modality for acute stroke. We sought to describe feasibility, safety and clinical outcomes in a consecutive series of patients in whom MAT was performed as the first treatment modality with other techniques used only in case MAT did not yield adequate recanalization.
Methods:
Retrospective review of a prospectively acquired acute endovascular stroke database. Primary MAT was carried out with a preference for the largest catheter considered to be trackable into the target lesion which was wedged into the thrombus followed by manual aspiration with a 20 cc syringe.
Results:
112 consecutive patients were identified. Median age: 67. Median NIHSS: 17. Occlusion location: M1(62.5%), M2(8%), ICA-terminus(18.7%), vertebrobasilar (10.7%).Patients with anterior occlusions had tandem extra/intracranial occlusive lesions in 18.7% Median time from symptoms onset to groin puncture: 267 min and from groin puncture to recanalization: 70 min. Aspiration was carried out with the following catheters makes and sizes (in inches): Navien (Covidien Inc.) 0.072 and 0.058 (84% of cases), Penumbra (Penumbra Inc. 0.054 and 0.041 (23% of cases) and DAC (Stryker Inc.) 0.070, 0.054 and 0.44 (4% of cases). Largest bore catheters (0.070 inch and above) were used in 27% of cases and in 75 % of cases medium size catheters (0.054 -0.058 in) catheter were used. Successful recanalization (TICI 2B-3) following MAT alone was 59% with 41% of patients requiring the use of adjunctive intra-arterial therapy (mainly stentriever and/or t-PA). Recanalization results were: TICI 2b/3- 86%, and TICI 3 -30%. Median number of passes: 2. Parenchymal hematoma of any type (PH1/PH2): 9.9%. Favorable outcomes (90-day modified Rankin Scale ≤2): 46.%. Mortality rate at 3 months:31%. Intracranial distal wire perforations were noted in 4 patients (3.5%).The use of MAT only was associated with faster procedural times (mean 63 min vs 97 min, p<0.0001) but not with higher rates of favorable outcomes. Neither catheter make nor size were associated with higher or faster recanlization rates
Conclusions:
Pure MAT is a safe, efficacious, quick, and potentially cost saving endovascular recanalization technique.
Retraction: Percutaneous Aspiration Thrombectomy for Arterial Thromboembolism during Infrainguinal Endovascular Recanalization
