The important role of manual aspiration through the guiding catheter during repeated solitaire mechanical thrombectomy in acute ischemic stroke.

Objective: Acute ischemic stroke (AIS) is an important global health problem. Intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the standard treatment. However, only a small number of patients benefit from it because of strict application restrictions. Increasing evidence has demonstrated that mechanical thrombectomy is an effective and safe therapy for AIS.

Patients And Methods: We present 14 cases of successful recanalization with Solitaire devices for AIS patients after stroke onset. During stent retrieval, continuous manual aspiration was applied through the guiding catheter, and several large pieces of thrombus were aspirated into the catheter along with the clot, which was adhered to the stent. Clinical outcomes were assessed by the NIHSS at discharge and the mRS on follow-up at 90 days.

Results: All 14 patients with AIS occlusions were treated with Solitaire stents during the study period. The successful recanalization rate was 100%. On discharge, all patients (100%) had improved (NIHSS of ≥ 10 points). At 90 days, 12 patients (86%) had a good functional outcome with mRS of ≤  2.

Conclusions: We recommend the use of manual aspiration through a guiding catheter as an alternative technique when a specialized aspiration device is not available, to facilitate a fast, complete, and safe thrombus retrieval by the Solitaire system.