• Thrombectomy

We thank the authors for their interest in the ‘plunger’ technique for direct aspiration thrombectomy and appreciate the concerns they raised about patient safety after watching our technical video1,2.

First, we would like to clarify how the plunger technique is performed. While it would seem obvious to almost any neuro-interventionalist, we must emphasize that at no point is the plunger actively pushed forward. In the video,2 the manual technique of cyclic aspiration is demonstrated at slow and fast speeds during a patient case. The plunger technique is initiated identically to standard manual aspiration, in our case with a 60 cc VacLok syringe being fully opened to 60 mL, to create a vacuum within the closed clot-catheter-syringe system. The syringe plunger is then released, not pushed, allowing it to naturally return to …