Impact and Effectiveness of Dual Aspiration Technique in Stent-Assisted Mechanical Thrombectomy: Recent Improvements in Acute Stroke Management.

BACKGROUND AND PURPOSE: To evaluate feasibility and impact of dual aspiration technique (DAT) within stent-assisted mechanical thrombectomy on procedural parameters and clinical outcome.

MATERIALS AND METHODS: Within 16 months, 76 consecutive patients (mean age 70.7 year; range 33-89) underwent stent-assisted mechanical thrombectomy. Of 52 enrolled patients (68.4 %) with occlusion of the anterior circulation, 22 patients (42.3 %) underwent DAT; 30 patients (57.7 %) were treated in conventional monoaspiration technique (MAT). Epidemiological data, clinical and imaging characteristics (mRS, NIHSS, ASPECTS) as well as procedural details were analyzed (TICI, number of retrieval, procedure time). Clinical outcome was determined with mRS at discharge and after 90 days.

RESULTS: In the context of DAT additional carotid artery stenting was required in 45.5 % (10/22) in underlying tandem lesion (vs. 0/30 MAT). No differences were found in NIHSS at admission (MAT: 20.5, range 15-29; DAT: 18.6; range 11-25), mRS at admission (MAT: 4.6 vs. DAT: 4.57) or ASPECT score (MAT: 8.3, ±1.5; DAT: 8.4, ±1.5; P > 0.05). TICI ≥ 2b/3 was conducted in 90 % (MAT) and 100 % (DAT), respectively. The procedure time was longer in the MAT group (65 min, ±25.9, range 18-126) compared to the DAT group (49.7 min, ±15, range 32-101; P = 0.016). The clinical outcome increased from admission to discharge and in follow-up after 90 days (mRS ≥ 2: MAT: 53.3 %, DAT: 54.5 %; P > 0.05).

CONCLUSIONS: The dual aspiration technique with an additional intermediate guide catheter placed closed to the stent retriever leads to decreased procedure time in the anterior circulation. Even in cases with higher thrombus load and treated in DAT, clinical outcome improved.