{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T15:45:45Z","timestamp":1794498345703,"version":"4.9.1"},"reference-count":30,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2014,12,1]]},"published-print":{"date-parts":[[2016,2]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>There is a discrepancy in clinical outcomes and the achieved recanalization rates with stent retrievers in the endovascular treatment of ischemic stroke. It is our hypothesis that procedural release of embolic particulate may be one contributor to poor outcomes and is a modifiable risk. The goal of this study is to assess various treatment strategies that reduce the risk of distal emboli.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Mechanical thrombectomy was simulated in a vascular phantom with collateral circulation. Hard fragment-prone clots (HFC) and soft elastic clots (SECs) were used to generate middle cerebral artery (MCA) occlusions that were retrieved by the Solitaire FR devices through (1) an 8\u2005Fr balloon guide catheter (BGC), (2) a 5\u2005Fr distal access catheter at the proximal aspect of the clot in the MCA (Solumbra), or (3) a 6\u2005Fr guide catheter with the tip at the cervical internal carotid artery (guide catheter, GC). Results from mechanical thrombectomy were compared with those from direct aspiration using the Penumbra 5MAX catheter. The primary endpoint was the size distribution of emboli to the distribution of the middle and anterior cerebral arteries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Solumbra was the most efficient method for reducing HFC fragments (p&lt;0.05) while BGC was the best method for preventing SEC fragmentation (p&lt;0.05). The risk of forming HFC distal emboli (&gt;1000\u2005\u00b5m) was significantly increased using GC. A non-statistically significant benefit of direct aspiration was observed in several subgroups of emboli with size 50\u20131000\u2005\u00b5m. However, compared with the stent-retriever mechanical thrombectomy techniques, direct aspiration significantly increased the risk of SEC fragmentation (&lt;50\u2005\u00b5m) by at least twofold.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The risk of distal embolization is affected by the catheterization technique and clot mechanics.<\/jats:p><\/jats:sec>","DOI":"10.1136\/neurintsurg-2014-011491","type":"journal-article","created":{"date-parts":[[2014,12,25]],"date-time":"2014-12-25T03:03:31Z","timestamp":1419476611000},"page":"197-202","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":209,"title":["Risk of distal embolization with stent retriever thrombectomy and ADAPT"],"prefix":"10.1136","volume":"8","author":[{"given":"Ju-Yu","family":"Chueh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajit S","family":"Puri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay K","family":"Wakhloo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J","family":"Gounis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2014,12,24]]},"reference":[{"key":"2024052302125208000_8.2.197.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61299-9"},{"key":"2024052302125208000_8.2.197.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61384-1"},{"key":"2024052302125208000_8.2.197.3","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2013-010870.3"},{"key":"2024052302125208000_8.2.197.4","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1161\/STROKEAHA.113.002407","article-title":"Balloon guide catheter improves revascularization and clinical outcomes with the Solitaire device: analysis of the North American Solitaire Acute Stroke Registry","volume":"45","author":"Nguyen","year":"2013","journal-title":"Stroke"},{"key":"2024052302125208000_8.2.197.5","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2013-010986"},{"key":"2024052302125208000_8.2.197.6","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.002673"},{"key":"2024052302125208000_8.2.197.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2012.07.012"},{"key":"2024052302125208000_8.2.197.8","first-page":"S16","article-title":"Reperfusion therapies for acute ischemic stroke: current pharmacological and mechanical approaches","volume":"42","author":"Molina","year":"2010","journal-title":"Stroke"},{"key":"2024052302125208000_8.2.197.9","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A3462"},{"key":"2024052302125208000_8.2.197.10","doi-asserted-by":"crossref","first-page":"734","DOI":"10.3174\/ajnr.A3746","article-title":"Stent retrievers in acute ischemic stroke: complications and failures during the perioperative period","volume":"35","author":"Gascou","year":"2013","journal-title":"AJNR Am J Neuroradiol"},{"key":"2024052302125208000_8.2.197.11","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1136\/neurintsurg-2013-010713","article-title":"Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy","volume":"6","author":"Turk","year":"2013","journal-title":"J Neurointerv Surg"},{"key":"2024052302125208000_8.2.197.12","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181d76b8f"},{"key":"2024052302125208000_8.2.197.13","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/j.wneu.2012.10.012","article-title":"Solitaire FR\u2014a promising new device for acute ischemic stroke treatment","volume":"78","author":"Mokin","year":"2012","journal-title":"World Neurosurg"},{"key":"2024052302125208000_8.2.197.14","doi-asserted-by":"publisher","DOI":"10.1159\/000338903"},{"key":"2024052302125208000_8.2.197.15","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.670463"},{"key":"2024052302125208000_8.2.197.16","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A3103"},{"key":"2024052302125208000_8.2.197.17","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2014-011125"},{"key":"2024052302125208000_8.2.197.18","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.646117"},{"key":"2024052302125208000_8.2.197.19","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A1543"},{"key":"2024052302125208000_8.2.197.20","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A2485"},{"key":"2024052302125208000_8.2.197.21","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.24317"},{"key":"2024052302125208000_8.2.197.22","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A3442"},{"key":"2024052302125208000_8.2.197.23","doi-asserted-by":"publisher","DOI":"10.1227\/01.neu.0000429859.96652.57"},{"key":"2024052302125208000_8.2.197.24","doi-asserted-by":"crossref","first-page":"524","DOI":"10.3174\/ajnr.A3707","article-title":"Complications of endovascular treatment for acute stroke in the SWIFT trial with solitaire and Merci devices","volume":"35","author":"Akins","year":"2013","journal-title":"AJNR Am J Neuroradiol"},{"key":"2024052302125208000_8.2.197.25","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-013-1191-4"},{"key":"2024052302125208000_8.2.197.26","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1136\/neurintsurg-2011-010216","article-title":"Incidence and outcome of procedural distal emboli using the Penumbra thrombectomy for acute stroke","volume":"5","author":"Todo","year":"2012","journal-title":"J Neurointerv Surg"},{"key":"2024052302125208000_8.2.197.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2012.10.037"},{"key":"2024052302125208000_8.2.197.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2005.02.048"},{"key":"2024052302125208000_8.2.197.29","doi-asserted-by":"publisher","DOI":"10.1016\/S0741-5214(00)90317-3"},{"key":"2024052302125208000_8.2.197.30","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000083400.80296.38"}],"container-title":["Journal of NeuroInterventional Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/neurintsurg-2014-011491","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T10:38:21Z","timestamp":1716460701000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnis.bmj.com\/lookup\/doi\/10.1136\/neurintsurg-2014-011491"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,12,24]]},"references-count":30,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2016,1,13]]},"published-print":{"date-parts":[[2016,2]]}},"alternative-id":["10.1136\/neurintsurg-2014-011491"],"URL":"https:\/\/doi.org\/10.1136\/neurintsurg-2014-011491","relation":{},"ISSN":["1759-8478","1759-8486"],"issn-type":[{"value":"1759-8478","type":"print"},{"value":"1759-8486","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,12,24]]}}}