Primary Aspiration Technique in Endovascular Stroke Treatment

Purpose: To investigate the safety and efficacy of “Primary Aspiration Technique” as an initial approach for intracranial artery occlusions in treatment of acute ischaemic stroke. Material and Methods: A total of 107 patients with acute large intracerebral artery occlusions located in the anterior or posterior circulation were included in the study. All the patients were treated with “Primary Aspiration Technique” by using either the Penumbra ACE or the ACE 64 aspiration catheter (Penumbra Inc.). Recanalisation results were assessed by follow-up angiography immediately after the procedure. Neurological evaluation using the National Institutes of Health Stroke Scale and modified Rankin Scale (mRS) was performed on admission and at discharge. Results: “Primary Aspiration Technique” alone was successfully used in 65% of the cases. The overall recanalisation rates were achieved in 88.8% of the cases. In 37 of the 107 cases (35%) secondary stent retriever devices were used in addition. If primary aspiration was successful, the median time from groin puncture until final recanalisation was 32 minutes. An early good clinical outcome at discharge (mRS ≤2) was seen in a total of 50 patients (47%). In-hospital mortality was 15% (16/107). 58.6% (41/70) of the patients achieved an early good clinical outcome (mRS ≤2) when primary aspiration technique was successful. By performing primary aspiration in different vessels the chance of receiving a Thrombolysis In Cerebral Infarction score ≥2b in the middle cerebral artery was 2.3 times higher than in the terminal internal carotid artery. Conclusions: “Primary Aspiration Technique” is a safe and effective endovascular thrombectomy method. The main advantages of aspiration technique are the fast procedure time and the high rate of favourable clinical outcome if primary aspiration is successful.