Application and research progress of aspiration thrombectomy in acute ischemic stroke_West China Medical Journal

Authors：

LIAO Jiachuan ,  WU Bo

Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WU Bo, Email: dragonwb@126.com

Keywords：

Acute ischemic stroke; endovascular treatment; aspiration thrombectomy

DOI：

10.7507/1002-0179.202205004

Video：

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Endovascular treatment for acute ischemic stroke has become the main therapy for large vessel occlusion. In addition to stent thrombectomy, in recent years, the application of aspiration thrombectomy is becoming more and more common. The physical principles of aspiration and stent thrombectomy extraction are different. The thrombus is captured by the negative pressure generated by suction through the contact between the reperfusion catheter and the thrombus, thus achieving cerebrovascular recanalization. Currently, more and more researches support the application of aspiration thrombectomy. What are the advantages and disadvantages of the aspiration thrombectomy compared with the stent thrombectomy and how to apply the aspiration technology reasonably are the hot issues concerned by everyone. This paper reviews the application and research progress of aspirating thrombectomy in order to provide reference for clinical treatment decisions.

Citation： LIAO Jiachuan, WU Bo. Application and research progress of aspiration thrombectomy in acute ischemic stroke. West China Medical Journal, 2022, 37(6): 921-925. doi: 10.7507/1002-0179.202205004 Copy

1.	Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet, 2016, 23,387(10029): 1723-1731.
2.	Bose A, Henkes H, Alfke K, et al. The penumbra system: a mechanical device for the treatment of acute stroke due to thromboembolism. AJNR Am J Neuroradiol, 2008, 29(7): 1409-1413.
3.	Tenser MS, Amar AP, Mack WJ. Mechanical thrombectomy for acute ischemic stroke using the MERCI retriever and penumbra aspiration systems. World Neurosurg, 2011, 76(6 Suppl): S16-S23.
4.	Kang DH, Hwang YH, Kim YS, et al. Direct thrombus retrieval using the reperfusion catheter of the penumbra system: forced-suction thrombectomy in acute ischemic stroke. AJNR Am J Neuroradiol, 2011, 32(2): 283-287.
5.	Turk AS, Spiotta A, Frei D, et al. Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg, 2014, 6(3): 231-237.
6.	Jankowitz B, Grandhi R, Horev A, et al. Primary manual aspiration thrombectomy (MAT) for acute ischemic stroke: safety, feasibility and outcomes in 112 consecutive patients. J Neurointerv Surg, 2015, 7(1): 27-31.
7.	Neki H, Katano T, Maeda T, et al. Familiarization with contact aspiration using non-penetrating of the thrombus (CANP) technique as the initial procedure for acute ischemic stroke. J Stroke Cerebrovasc Dis, 2021, 30(11): 106066.
8.	Lee JS, Hong JM, Lee SJ, et al. The combined use of mechanical thrombectomy devices is feasible for treating acute carotid terminus occlusion. Acta Neurochir (Wien), 2013, 155(4): 635-641.
9.	Humphries W, Hoit D, Doss VT, et al. Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke. J Neurointerv Surg, 2015, 7(2): 90-94.
10.	Maus V, Behme D, Kabbasch C, et al. Maximizing first-pass complete reperfusion with save. Clin Neuroradiol, 2018, 28(3): 327-338.
11.	McTaggart RA, Tung EL, Yaghi S, et al. Continuous aspiration prior to intracranial vascular embolectomy (CAPTIVE): a technique which improves outcomes. J Neurointerv Surg, 2017, 9(12): 1154-1159.
12.	Wiesmann M, Brockmann MA, Heringer S, et al. Active push deployment technique improves stent/vessel-wall interaction in endovascular treatment of acute stroke with stent retrievers. J Neurointerv Surg, 2017, 9(3): 253-256.
13.	Turk AS, Frei D, Fiorella D, et al. ADAPT fast study: a direct aspiration first pass technique for acute stroke thrombectomy. J Neurointerv Surg, 2014, 6(4): 260-264.
14.	Kowoll A, Weber A, Mpotsaris A, et al. Direct aspiration first pass technique for the treatment of acute ischemic stroke: initial experience at a European stroke center. J Neurointerv Surg, 2016, 8(3): 230-234.
15.	Lapergue B, Blanc R, Guedin P, et al. A direct aspiration, first pass technique (ADAPT) versus stent retrievers for acute stroke therapy: an observational comparative study. AJNR Am J Neuroradiol, 2016, 37(10): 1860-1865.
16.	Son S, Choi DS, Oh MK, et al. Comparison of solitaire thrombectomy and penumbra suction thrombectomy in patients with acute ischemic stroke caused by basilar artery occlusion. J Neurointerv Surg, 2016, 8(1): 13-18.
17.	Lapergue B, Blanc R, Gory B, et al. Effect of endovascular contact aspiration vs stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion: the ASTER randomized clinical trial. JAMA, 2017, 318(5): 443-452.
18.	Turk AS 3rd, Siddiqui A, Fifi JT, et al. Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial. Lancet, 2019, 393(10175): 998-1008.
19.	Phan K, Dmytriw AA, Teng I, et al. A direct aspiration first pass technique vs standard endovascular therapy for acute stroke: a systematic review and meta-analysis. Neurosurgery, 2018, 83(1): 19-28.
20.	Hsieh KL, Chuang KI, Weng HH, et al. First-line a direct aspiration first-pass technique vs. first-line stent retriever for acute ischemic stroke therapy:a meta-analysis. Front Neurol, 2018, 9: 801.
21.	Tsang COA, Cheung IHW, Lau KK, et al. Outcomes of stent retriever versus aspiration-first thrombectomy in ischemic stroke: a systematic review and meta-analysis. AJNR Am J Neuroradiol, 2018, 39(11): 2070-2076.
22.	Boulanger M, Lapergue B, Turjman F, et al. First-line contact aspiration vs stent-retriever thrombectomy in acute ischemic stroke patients with large-artery occlusion in the anterior circulation: systematic review and meta-analysis. Interv Neuroradiol, 2019, 25(3): 244-253.
23.	Primiani CT, Vicente AC, Brannick MT, et al. Direct aspiration versus stent retriever thrombectomy for acute stroke: a systematic review and meta-analysis in 9127 patients. J Stroke Cerebrovasc Dis, 2019, 28(5): 1329-1337.
24.	Zhang X, Guo X, Yi Y, et al. First-line contact aspiration vs stent retriever for proximal occlusion in acute ischemic stroke: a systemic review and meta-analysis. J Stroke Cerebrovasc Dis, 2020, 29(12): 105374.
25.	Zhang Y, Zhang Y, Hu C, et al. A direct aspiration first-pass technique (ADAPT) versus stent retriever for acute ischemic stroke (AIS): a systematic review and meta-analysis. J Neurol, 2021, 268(12): 4594-4606.
26.	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组, 中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性脑卒中早期血管内介入诊疗指南 2018. 中华神经科杂志, 2018, 51(9): 683-691.
27.	Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2019, 50(12): e344-e418.
28.	Xing PF, Yang PF, Li ZF, et al. Comparison of aspiration versus stent retriever thrombectomy as the preferred strategy for patients with acute terminal internal carotid artery occlusion: a propensity score matching analysis. AJNR Am J Neuroradiol, 2020, 41(3): 469-476.
29.	Diana F, Vinci SL, Ruggiero M, et al. Comparison of aspiration versus combined technique as first-line approach in terminal internal carotid artery occlusion: a multicenter experience. J Neurointerv Surg, 2021: 1-7.
30.	Gory B, Lapergue B, Blanc R, et al. Contact aspiration versus stent retriever in patients with acute ischemic stroke with M2 occlusion in the ASTER randomized trial (contact aspiration versus stent retriever for successful revascularization). Stroke, 2018, 49(2): 461-464.
31.	Bernsen MLE, Goldhoorn RB, Lingsma HF, et al. Importance of occlusion site for thrombectomy technique in stroke: comparison between aspiration and stent retriever. Stroke, 2021, 52(1): 80-90.
32.	Onodera K, Kurisu K, Sakurai J, et al. A direct aspiration first pass technique for vertebra-basilar occlusion: a retrospective comparison to stent retriever. J Stroke Cerebrovasc Dis, 2021, 30(11): 106069.
33.	Yoo J, Lee SJ, Hong JH, et al. Immediate effects of first-line thrombectomy devices for intracranial atherosclerosis-related occlusion: stent retriever versus contact aspiration. BMC Neurol, 2020, 20(1): 283.

1. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet, 2016, 23,387(10029): 1723-1731.
2. Bose A, Henkes H, Alfke K, et al. The penumbra system: a mechanical device for the treatment of acute stroke due to thromboembolism. AJNR Am J Neuroradiol, 2008, 29(7): 1409-1413.
3. Tenser MS, Amar AP, Mack WJ. Mechanical thrombectomy for acute ischemic stroke using the MERCI retriever and penumbra aspiration systems. World Neurosurg, 2011, 76(6 Suppl): S16-S23.
4. Kang DH, Hwang YH, Kim YS, et al. Direct thrombus retrieval using the reperfusion catheter of the penumbra system: forced-suction thrombectomy in acute ischemic stroke. AJNR Am J Neuroradiol, 2011, 32(2): 283-287.
5. Turk AS, Spiotta A, Frei D, et al. Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg, 2014, 6(3): 231-237.
6. Jankowitz B, Grandhi R, Horev A, et al. Primary manual aspiration thrombectomy (MAT) for acute ischemic stroke: safety, feasibility and outcomes in 112 consecutive patients. J Neurointerv Surg, 2015, 7(1): 27-31.
7. Neki H, Katano T, Maeda T, et al. Familiarization with contact aspiration using non-penetrating of the thrombus (CANP) technique as the initial procedure for acute ischemic stroke. J Stroke Cerebrovasc Dis, 2021, 30(11): 106066.
8. Lee JS, Hong JM, Lee SJ, et al. The combined use of mechanical thrombectomy devices is feasible for treating acute carotid terminus occlusion. Acta Neurochir (Wien), 2013, 155(4): 635-641.
9. Humphries W, Hoit D, Doss VT, et al. Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke. J Neurointerv Surg, 2015, 7(2): 90-94.
10. Maus V, Behme D, Kabbasch C, et al. Maximizing first-pass complete reperfusion with save. Clin Neuroradiol, 2018, 28(3): 327-338.
11. McTaggart RA, Tung EL, Yaghi S, et al. Continuous aspiration prior to intracranial vascular embolectomy (CAPTIVE): a technique which improves outcomes. J Neurointerv Surg, 2017, 9(12): 1154-1159.
12. Wiesmann M, Brockmann MA, Heringer S, et al. Active push deployment technique improves stent/vessel-wall interaction in endovascular treatment of acute stroke with stent retrievers. J Neurointerv Surg, 2017, 9(3): 253-256.
13. Turk AS, Frei D, Fiorella D, et al. ADAPT fast study: a direct aspiration first pass technique for acute stroke thrombectomy. J Neurointerv Surg, 2014, 6(4): 260-264.
14. Kowoll A, Weber A, Mpotsaris A, et al. Direct aspiration first pass technique for the treatment of acute ischemic stroke: initial experience at a European stroke center. J Neurointerv Surg, 2016, 8(3): 230-234.
15. Lapergue B, Blanc R, Guedin P, et al. A direct aspiration, first pass technique (ADAPT) versus stent retrievers for acute stroke therapy: an observational comparative study. AJNR Am J Neuroradiol, 2016, 37(10): 1860-1865.
16. Son S, Choi DS, Oh MK, et al. Comparison of solitaire thrombectomy and penumbra suction thrombectomy in patients with acute ischemic stroke caused by basilar artery occlusion. J Neurointerv Surg, 2016, 8(1): 13-18.
17. Lapergue B, Blanc R, Gory B, et al. Effect of endovascular contact aspiration vs stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion: the ASTER randomized clinical trial. JAMA, 2017, 318(5): 443-452.
18. Turk AS 3rd, Siddiqui A, Fifi JT, et al. Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): a multicentre, randomised, open label, blinded outcome, non-inferiority trial. Lancet, 2019, 393(10175): 998-1008.
19. Phan K, Dmytriw AA, Teng I, et al. A direct aspiration first pass technique vs standard endovascular therapy for acute stroke: a systematic review and meta-analysis. Neurosurgery, 2018, 83(1): 19-28.
20. Hsieh KL, Chuang KI, Weng HH, et al. First-line a direct aspiration first-pass technique vs. first-line stent retriever for acute ischemic stroke therapy:a meta-analysis. Front Neurol, 2018, 9: 801.
21. Tsang COA, Cheung IHW, Lau KK, et al. Outcomes of stent retriever versus aspiration-first thrombectomy in ischemic stroke: a systematic review and meta-analysis. AJNR Am J Neuroradiol, 2018, 39(11): 2070-2076.
22. Boulanger M, Lapergue B, Turjman F, et al. First-line contact aspiration vs stent-retriever thrombectomy in acute ischemic stroke patients with large-artery occlusion in the anterior circulation: systematic review and meta-analysis. Interv Neuroradiol, 2019, 25(3): 244-253.
23. Primiani CT, Vicente AC, Brannick MT, et al. Direct aspiration versus stent retriever thrombectomy for acute stroke: a systematic review and meta-analysis in 9127 patients. J Stroke Cerebrovasc Dis, 2019, 28(5): 1329-1337.
24. Zhang X, Guo X, Yi Y, et al. First-line contact aspiration vs stent retriever for proximal occlusion in acute ischemic stroke: a systemic review and meta-analysis. J Stroke Cerebrovasc Dis, 2020, 29(12): 105374.
25. Zhang Y, Zhang Y, Hu C, et al. A direct aspiration first-pass technique (ADAPT) versus stent retriever for acute ischemic stroke (AIS): a systematic review and meta-analysis. J Neurol, 2021, 268(12): 4594-4606.
26. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组, 中华医学会神经病学分会神经血管介入协作组. 中国急性缺血性脑卒中早期血管内介入诊疗指南 2018. 中华神经科杂志, 2018, 51(9): 683-691.
27. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2019, 50(12): e344-e418.
28. Xing PF, Yang PF, Li ZF, et al. Comparison of aspiration versus stent retriever thrombectomy as the preferred strategy for patients with acute terminal internal carotid artery occlusion: a propensity score matching analysis. AJNR Am J Neuroradiol, 2020, 41(3): 469-476.
29. Diana F, Vinci SL, Ruggiero M, et al. Comparison of aspiration versus combined technique as first-line approach in terminal internal carotid artery occlusion: a multicenter experience. J Neurointerv Surg, 2021: 1-7.
30. Gory B, Lapergue B, Blanc R, et al. Contact aspiration versus stent retriever in patients with acute ischemic stroke with M2 occlusion in the ASTER randomized trial (contact aspiration versus stent retriever for successful revascularization). Stroke, 2018, 49(2): 461-464.
31. Bernsen MLE, Goldhoorn RB, Lingsma HF, et al. Importance of occlusion site for thrombectomy technique in stroke: comparison between aspiration and stent retriever. Stroke, 2021, 52(1): 80-90.
32. Onodera K, Kurisu K, Sakurai J, et al. A direct aspiration first pass technique for vertebra-basilar occlusion: a retrospective comparison to stent retriever. J Stroke Cerebrovasc Dis, 2021, 30(11): 106069.
33. Yoo J, Lee SJ, Hong JH, et al. Immediate effects of first-line thrombectomy devices for intracranial atherosclerosis-related occlusion: stent retriever versus contact aspiration. BMC Neurol, 2020, 20(1): 283.

West China Medical Journal

Application and research progress of aspiration thrombectomy in acute ischemic stroke

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