The SAVE Technique : Large-Scale Experience for Treatment of Intracranial Large Vessel Occlusions.

BACKGROUND: The stent retriever assisted vacuum-locked extraction (SAVE) technique was introduced as an effective thrombectomy method in stroke patients suffering from intracranial large vessel occlusion (LVO). This article presents our multicenter, large-scale experience with SAVE. METHODS: The study involved a retrospective core team analysis of 200 patients undergoing mechanical thrombectomy using the SAVE technique due to intracranial LVO at 4 German centers. Primary endpoints were first-pass and overall complete/near complete reperfusion, defined as a modified thrombolysis in cerebral infarction (mTICI) score of 2c and 3. Secondary endpoints were the number of passes, time from groin puncture to reperfusion, embolization to new territories (ENT), postinterventional symptomatic intracranial hemorrhage (sICH), and favorable outcome at discharge, defined as a modified Rankin Scale (mRS) score ≤ 2. RESULTS: The median age was 78 years (interquartile range IQR 68-85). Median National Institutes of Health stroke scale (NIHSS) at admission was 16 (IQR 12-20). Occlusions sites were: internal carotid artery (ICA-T) in 39/200 (19.5%), M1 in 126/200 (63%), M2 in 30/200 (15%), and others in 5/200 (2.5%) cases. The primary endpoints were documented in 114/200 (57% first pass mTICI 2c or 3) and 154/200 (77% overall mTICI 2c or 3) patients, respectively. The overall median time from groin puncture to reperfusion was 34 min (IQR 25-52) with a median of 1 (IQR 1-2) attempts. An ENT was observed in 3 patients (1.5%) and the rate of sICH was 2.6%. The rate of successful reperfusion (mTICI ≥ 2b) on final angiograms was 95%. At discharge, 73/200 (36.5%) patients revealed a favorable outcome. CONCLUSION: Mechanical thrombectomy using the SAVE technique seems to be effective, fast and safe. First-line use of SAVE leads to high rates of complete and near complete reperfusion.

Stent retriever placement in embolectomy: the choice of the post-bifurcational trunk influences the first-pass reperfusion result in M1 occlusions.

BACKGROUND: Embolectomy using Stent retriever Assisted Vacuum-locked Extraction (SAVE) is effective in intracranial large vessel occlusion. Which post-bifurcational trunk should be chosen for distal stent retriever placement in M1 occlusions is, however, elusive. METHODS: We conducted a retrospective analysis of prospectively collected data from a comprehensive stroke center between 2015 and 2017. Eighty-nine consecutive patients with M1 occlusions were treated with SAVE. Digital subtraction angiography (DSA) series were studied to determine the anatomy of middle cerebral artery division, the position of the stent retriever, and to measure vessel diameters. The primary endpoint was first-pass complete/near-complete reperfusion, defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score of 2c or 3, after distal stent retriever placement in the inferior trunk. RESULTS: In 76/89 (85%) patients, microcatheter series were documented. A microcatheter was placed within the inferior trunk in 30/76 (40%) cases. First-pass near-complete/complete reperfusion was more likely to be achieved when the inferior trunk was used for stent retriever placement rather than the superior trunk (mTICI ≥2c: 22/30 (73%) vs 22/46 (48%), P=0.034; and mTICI 3: 20/30 (67%) vs 17/46 (37%), P=0.018). Median diameter of the inferior trunk was larger than the superior trunk (1.4 mm (IQR 1.26-1.62) vs 1.18 mm (IQR 0.98-1.43), P=0.011). The inferior trunk was dominant in 56/76 (74%) cases. Successful reperfusion was associated with placement within the dominant trunk (33/40 (83%) vs 22/36 (61%), P=0.044). CONCLUSION: The choice of the inferior trunk for distal stent retriever placement in M1 occlusions is associated with a high rate of first-pass near-complete/complete reperfusion when using SAVE.