J Cerebrovasc Endovasc Neurosurg.  2015 Mar;17(1):13-19. 10.7461/jcen.2015.17.1.13.

A Suction Thrombectomy Technique: A Rapid and Effective Method for Intra-Arterial Thrombolysis

• Park H

• KMID: 1963144
• DOI: http://doi.org/10.7461/jcen.2015.17.1.13

Abstract

OBJECTIVE
During mechanical thrombolysis, to reduce procedure-related complications and time, the authors have performed a simple suction thrombectomy technique. In this article, the authors describe the technical details and clinical outcomes of this technique.
MATERIALS AND METHODS
From January 2013 to December 2013, 14 consecutive acute ischemic stroke (AIS) patients with large cerebral arterial occlusions in the middle cerebral artery (MCA; n = 7), internal cerebral artery (ICA; n = 5), basilar artery (BA; n = 1), and a tandem lesion (ICA and MCA; n = 1) were treated using this technique. The proximal part of the occluding clot was aspirated or captured and retrieved as one piece using a large bored microcatheter by applying negative suction pressure using a 50 mL syringe.
RESULTS
Overall recanalization rate was 85.7% (12 patients). In the 8 patients in whom this technique was used alone, the recanalization rate was 87.5% (7 patients). The median procedural duration was 30 minutes (range 17-112) in these 7 patients. Distal embolism did not occur. Two patients developed post-procedural intracerebral hemorrhages and one was symptomatic. His modified Rankin Scale (mRS) score at 90 days was 4.
CONCLUSION
This technique is a feasible, fast, and safe method for treatment of AIS.

Keyword

Acute; Stroke; Thrombolysis; Suction; Thrombectomy

MeSH Terms

Basilar Artery
Cerebral Arteries
Cerebral Hemorrhage
Embolism
Humans
Mechanical Thrombolysis
Middle Cerebral Artery
Stroke
Suction*
Syringes
Thrombectomy*

Figure

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  Fig. 1 Aspiration gun

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  Fig. 2 A 93-year-old female with right-side hemiparesis. There was acute infarction in the left basal ganglia and the corona radiata on Diffusion magnetic resornance (MR) (A). Perfusion MR showed decreased perfusion decrease in the left middle cerebral artery (MCA) territory (B). Complete occlusion of the proximal M1 segment of the left MCA was found on brain MR angiogram (C). An angiogram showed occlusion of the proximal M1 (D). The suction catheter tip was wedged to the proximal part of the thrombus (E). The whole thrombus was retrieved as one piece (F). Post procedural distal subtractive angiogram showed complete recanalization of the occlusion site (G)

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