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Original research
Optimizing endovascular stroke treatment: removing the microcatheter before clot retrieval with stent-retrievers increases aspiration flow
  1. Omid Nikoubashman1,2,
  2. Jan Patrick Alt1,
  3. Arash Nikoubashman3,
  4. Martin Büsen4,
  5. Sarah Heringer1,
  6. Carolin Brockmann1,
  7. Marc-Alexander Brockmann1,
  8. Marguerite Müller1,
  9. Arno Reich5,
  10. Martin Wiesmann1
  1. 1Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Aachen, Germany
  2. 2Department of Radiology, RWTH University Hospital Aachen, Aachen, Germany
  3. 3Institute of Physics, Johannes Gutenberg University Mainz, Mainz, Germany
  4. 4Institute of Applied Medical Engineering, RWTH University, Aachen, Germany
  5. 5Department of Neurology, RWTH University Hospital Aachen, Aachen, Germany
  1. Correspondence to Dr Omid Nikoubashman, Klinik für Neuroradiologie, Universitätsklinikum Aachen, Pauwelsstr 30, Aachen 52074, Germany; onikoubashman{at}


Background Flow control during endovascular stroke treatment with stent-retrievers is crucial for successful revascularization. The standard technique recommended by stent-retriever manufacturers implies obstruction of the respective access catheter by the microcatheter, through which the stent-retriever is delivered. This, in turn, results in reduced aspiration during thrombectomy. In order to maximize aspiration, we fully retract the microcatheter out of the access catheter before thrombectomy—an approach we term the ‘bare wire thrombectomy’ (BWT) technique. We verified the improved throughput with systematic in vitro studies and assessed the clinical effectiveness and safety of this method.

Methods We compared aspiration flow of water through various access catheters (5–8 F) with a Rebar microcatheter (0.18 inch and 0.27 inch) and a Trevo stent-retriever using the standard technique and the BWT technique in vitro. We also retrospectively analyzed 302 retrieval maneuvers in 117 patients who received endovascular treatment with a stent-retriever between February 2010 and April 2015.

Results In the in vitro experiment, removal of the microcatheter in all tested settings resulted in significantly increased aspiration flow through the access catheter (p<0.001). This effect was particularly pronounced in access catheters with a diameter of ≤7 F. In the clinical study, the revascularization rate (Thrombolysis In Cerebral Infarction ≥2b) was 91%. There were no complications associated with the BWT technique in 302 retrieval maneuvers.

Conclusions The BWT technique results in improved aspiration flow rates compared with the standard deployment technique. Our clinical data show that the BWT technique is effective and safe.

  • Stroke
  • Catheter
  • Balloon
  • Intervention
  • Stent

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