Department of Neuroradiology, Daegu-Gyeongbuk Cardiocerebrovascular Center, Kyungpook National University, Republic of Korea.
AJNR Am J Neuroradiol. 2011 Feb;32(2):283-7. doi: 10.3174/ajnr.A2299. Epub 2010 Nov 18.
Although the PS has been the most promising mechanical thrombectomy device in terms of recanalization rates, even the PS cannot recanalize all cases of occlusion. Under such circumstances, we simply modified the PS, identified certain advantages, and applied this modification as a primary technique for recanalization. Here we describe and discuss the technical details and results of our preliminary experience.
This study included 22 consecutive patients with acute ischemic stroke secondary to large-artery occlusion who underwent modified thrombectomy by using the PS for recanalization. Direct wedging between the tip of the reperfusion catheter and the proximal part of the clot followed by forceful suction by using a 20- or 50-mL syringe is a unique feature of this technique. What is distinctive is that this does not require use of a separator or aspiration pump.
All treated vessels (100%) were successfully recanalized. A TICI scale of 2b or 3 was achieved in 81.9% of patients. A 3-month favorable functional outcome (mRS score, 0-2) was achieved in 45.5% of patients. The only procedural complication was a transient dissection of the proximal ICA, which developed while advancing the guide catheter.
Forced-suction thrombectomy is a simple modification of the PS. On the basis of our data, this technique allows safe and effective revascularization in acute large-vessel occlusion. Thus, for achieving the best outcome, the modified PS technique is proposed as a viable option for acute stroke management, either by itself or in conjunction with other devices or drugs.
虽然 PS 是再通率最有前景的机械取栓装置，但即使是 PS 也不能使所有闭塞病例再通。在这种情况下，我们只是对 PS 进行了简单的修改，确定了某些优势，并将这种修改作为主要的再通技术应用。在此，我们描述并讨论了我们初步经验的技术细节和结果。
本研究纳入了 22 例因大动脉闭塞导致急性缺血性脑卒中的连续患者，这些患者使用 PS 进行改良取栓以实现再通。再灌注导管尖端与血栓近端之间的直接楔入，随后使用 20 或 50ml 注射器强力抽吸是该技术的独特特征。与众不同的是，这不需要使用分离器或抽吸泵。
所有治疗的血管（100%）均成功再通。81.9%的患者达到 TICI 分级 2b 或 3。45.5%的患者在 3 个月时获得了良好的功能结局（mRS 评分 0-2）。唯一的手术并发症是在推进导引导管时近端颈内动脉的短暂夹层。
强制抽吸血栓切除术是 PS 的简单改良。基于我们的数据，这种技术允许在急性大血管闭塞中进行安全有效的再血管化。因此，为了获得最佳结果，改良 PS 技术被提议作为急性脑卒中管理的可行选择，无论是单独使用还是与其他设备或药物联合使用。
