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Published in: Clinical Neuroradiology 1/2020

01-03-2020 | Original Article

Further Development of Combined Techniques Using Stent Retrievers, Aspiration Catheters and BGC

The PROTECTPLUS Technique

Authors: Christian Maegerlein, Maria Teresa Berndt, Sebastian Mönch, Kornelia Kreiser, Tobias Boeckh-Behrens, Manuel Lehm, Silke Wunderlich, Claus Zimmer, Benjamin Friedrich

Published in: Clinical Neuroradiology | Issue 1/2020

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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 PROTECTPLUS 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 PROTECTPLUS technique with respect to the technical and procedural parameters. Patients n = 165 (101 PROTECT, 64 PROTECTPLUS) with ELVO of either the terminus of the internal carotid artery or the proximal middle cerebral artery were included.

Results

Using the PROTECTPLUS resulted in a higher rate of first pass complete reperfusions (59.4% vs. 27.7%, p < 0.001) as compared with PROTECT. The PROTECTPLUS 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 PROTECTPLUS technique is a promising technical modification to further optimize endovascular stroke treatment.
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Metadata
Title
Further Development of Combined Techniques Using Stent Retrievers, Aspiration Catheters and BGC
The PROTECTPLUS Technique
Authors
Christian Maegerlein
Maria Teresa Berndt
Sebastian Mönch
Kornelia Kreiser
Tobias Boeckh-Behrens
Manuel Lehm
Silke Wunderlich
Claus Zimmer
Benjamin Friedrich
Publication date
01-03-2020
Publisher
Springer Berlin Heidelberg
Published in
Clinical Neuroradiology / Issue 1/2020
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI
https://doi.org/10.1007/s00062-018-0742-9

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