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Plunge with caution: safeguarding patients in mechanical thrombectomy
  1. Jonathan Cortese1,2,3,
  2. Esref Alperen Bayraktar1,
  3. Jiahui Li1,4,
  4. David F Kallmes1
  1. 1Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA
  2. 2Interventional Neuroradiology NEURI Vascular Center, Bicêtre Hospital, Le Kremlin-Bicêtre, Île-de-France, France
  3. 3INSERM U1195, Paris-Saclay University Faculty of Medicine, Le Kremlin-Bicetre, Ile-de-France, France
  4. 4Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
  1. Correspondence to Dr Jonathan Cortese, Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota, USA; cortese.jonathan{at}

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We watched the technical video explaining the ‘plunger technique’ for mechanical thrombectomy in acute ischemic stroke with great interest, as published by Froehler in the Journal of Neurointerventional Surgery.1 We were intrigued by the innovative approach presented in this video, and the author should be congratulated for attempting to find an alternative to upcoming cyclical aspiration devices. Indeed, cyclical aspiration may represent the next breakthrough that will achieve high rates of first-pass effect, as supported by several in vitro studies2–4 and a first clinical evaluation.5

However, on thorough review and consideration of the demonstrated technique, certain concerns have arisen. First, it is important to note that the plunger technique lacks substantial support from existing clinical data or previous publications. Several statements made by the author in the video are solely based on personal experience without proper retrospective or prospective evaluation.

Second, we are particularly concerned about the potential risks associated with the technique, notably the risk of air embolism or thrombus migration. Air …

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  • Contributors All authors contributed to the conception, design of the studies, the interpretation of the data and drafted the work or revised it for significant intellectual content. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work, including its accuracy and integrity.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JC received an educational grant from Medtronic, Phenox, Microvention, the French Society of Radiology and the French Society of Neuroradiology and received honoraria for lectures from Balt, all unrelated to this work. DFK received research support from Cerenovus, Sensome, Neurogami Medical, Insera Therapeutics, Medtronic, Microvention, Balt, Monarch Biosciences, Brainomix, MiVi, Stryker and NIH; royalties from Medtronic; is on the DSMB of NoNO Inc and Vesalio; is a stockholder of Nested Knowledge, Superior Medical Experts, Marblehead Medical, and Conway Medical, all unrelated to this work.

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