Further Development of Combined Techniques Using Stent Retrievers, Aspiration Catheters and BGC : The PROTECT Technique

Overview

Journal Clin Neuroradiol

Specialties Neurology
Radiology

Date 2018 Nov 11

PMID 30413831

Citations 38

Authors

Christian Maegerlein

Maria Teresa Berndt

Sebastian Monch

Kornelia Kreiser

Tobias Boeckh-Behrens

Manuel Lehm

Silke Wunderlich

Claus Zimmer

Benjamin Friedrich

Affiliations

Soon will be listed here.

Abstract

Purpose: First pass complete (mTICI 3) reperfusion must be regarded as the ultimate goal in mechanical thrombectomy (MT) in patients suffering from an emergent large vessel occlusion (ELVO). With this in mind a technical modification of the previously published PROTECT (PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy) approach, the PROTECT technique was evaluated. Under proximal flow arrest using a balloon guide catheter (BGC), a stent retriever was only partially inserted into a large-bore aspiration catheter. This construction was subsequently retracted as a unit into the BGC with aspiration both at the aspiration catheter and at the BGC.

Methods: A case-control study was performed comparing the PROTECT technique with the PROTECT technique with respect to the technical and procedural parameters. Patients n = 165 (101 PROTECT, 64 PROTECT) with ELVO of either the terminus of the internal carotid artery or the proximal middle cerebral artery were included.

Results: Using the PROTECT resulted in a higher rate of first pass complete reperfusions (59.4% vs. 27.7%, p < 0.001) as compared with PROTECT. The PROTECT also led to shorter procedure times (21 min vs. 37 min, p = 0.001) and higher rates of overall complete reperfusion (73.5% vs. 49.5%, p = 0.014) compared to PROTECT.

Conclusion: The PROTECT technique is a promising technical modification to further optimize endovascular stroke treatment.

Citing Articles

Current Approaches and Methods to Understand Acute Ischemic Stroke Treatment Using Aspiration Thrombectomy.

Patki P, Simon S, Costanzo F, Manning K Cardiovasc Eng Technol. 2024; 15(4):481-502.

PMID: 38886306 DOI: 10.1007/s13239-024-00735-0.

Mechanical thrombectomy using the retrograde semi-retrieval technique for patients with underlying intracranial atherosclerotic stenosis.

Wang W, Xu Y, Zhang B, Liu S, Ma Z, Wang S Front Neurol. 2024; 14:1280181.

PMID: 38283684 PMC: 10811598. DOI: 10.3389/fneur.2023.1280181.

Therapeutic management of ischemic stroke.

Bindal P, Kumar V, Kapil L, Singh C, Singh A Naunyn Schmiedebergs Arch Pharmacol. 2023; 397(5):2651-2679.

PMID: 37966570 DOI: 10.1007/s00210-023-02804-y.

A Patient with a Delayed Diagnosis of Artery of Percheron Occlusion in Whom Thrombectomy Was Effective.

Iwasaki M, Hikita C, Maeda M, Inaka Y, Yamazaki H, Fukuta S J Neuroendovasc Ther. 2023; 15(11):725-729.

PMID: 37502267 PMC: 10371001. DOI: 10.5797/jnet.cr.2020-0144.

The proximal balloon occlusion together with direct thrombus aspiration (protect plus) technique: Experience at a tertiary comprehensive stroke center.

Parra-Farinas C, Diestro J, Dmytriw A, Almusalam N, Rajendram P, Phillips R Neuroradiol J. 2023; 36(6):686-692.

PMID: 37211821 PMC: 10649534. DOI: 10.1177/19714009231177359.

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