TY - JOUR T1 - PROTECT: PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy – evaluation of a double embolic protection approach in endovascular stroke treatment JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 751 LP - 755 DO - 10.1136/neurintsurg-2017-013558 VL - 10 IS - 8 AU - Christian Maegerlein AU - Sebastian Mönch AU - Tobias Boeckh-Behrens AU - Manuel Lehm AU - Dennis M Hedderich AU - Maria Teresa Berndt AU - Silke Wunderlich AU - Claus Zimmer AU - Johannes Kaesmacher AU - Benjamin Friedrich Y1 - 2018/08/01 UR - http://jnis.bmj.com/content/10/8/751.abstract N2 - Purpose Stent retriever-based mechanical thrombectomy (MT) for emergent large vessel occlusions (ELVO) is often complicated by thrombus fragmentation causing distal embolization and embolization to new vascular territories. Well-established embolic protection approaches include proximal flow arrest and distal aspiration techniques during stent retriever maneuvers. Aiming at the reduction of thrombus fragmentation during MT we evaluated a technical approach combining proximal balloon occlusion together with direct thrombus aspiration during MT: the PROTECT technique.Methods We performed a case-control study comparing the PROTECT technique with sole distal aspiration during MT regarding technical and procedural parameters, n=200 patients with ELVO of either the terminus of the internal carotid artery or the proximal middle artery were included.Results PROTECT resulted in a shorter procedure time (29 vs 40 min; P=0.002), in a higher rate of successful recanalizations (100% vs 78%; P=0.001) and a higher rate of complete reperfusions (70% vs 39%; P<0.001) compared with sole distal aspiration during MT.Conclusion The PROTECT technique is a promising new approach to significantly reduce thrombus fragmentation and, hence distal embolization during MT. This safe and efficient technique needs to be validated in larger trials to confirm our results. ER -