{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T13:51:49Z","timestamp":1777729909686,"version":"3.51.4"},"reference-count":26,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T00:00:00Z","timestamp":1747094400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Interv Neuroradiol"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Factors responsible for failure of aspiration thrombectomy in patients with acute ischemic stroke are poorly understood. In order to examine catheter\u2013clot interactions, we modified our current aspiration thrombectomy technique by performing contrast injections near the tip of the aspiration catheter prior to the initiation of aspiration thrombectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Small volume injections of contrast were performed using a microcatheter positioned inside the aspiration catheter immediately proximal to the occlusion site. Continuous fluoroscopy during the entire duration of each aspiration pass was recorded. We report our initial results with this new technique and examine potential associations of patterns of contrast behavior with procedural success of each thrombectomy pass.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventeen patients were included in final analysis, consisting of 24 total aspiration thrombectomy passes. Microcatheter injections showed no safety concerns. Three angiographic patterns of contrast behavior near the aspiration catheter tip were observed: \u201cocclusive\u201d with no forward contrast flow, \u201cside branch opacification\u201d and \u201canterograde opacification\u201d with anterograde flow. Movement of the contrast column during aspiration thrombectomy depended on the degree of aspiration catheter redundancy. Manual reduction of excessive catheter turns and higher position of long guide sheath at the petrous or cavernous segments seemed to improve contrast clearance and aspiration force.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This initial experience indicates that multiple complex factors may affect success rates of aspiration thrombectomy. The technique of microcatheter injection near the occlusion site may prove helpful in optimizing the existing aspiration thrombectomy techniques.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15910199251341382","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T03:35:14Z","timestamp":1747107314000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Overcoming the black box of aspiration thrombectomy in acute ischemic stroke: An early clinical experience of using contrast injections to understand clot-catheter interactions"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5160-802X","authenticated-orcid":false,"given":"Elliott","family":"Pressman","sequence":"first","affiliation":[{"name":"Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheyar","family":"Amin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kunal","family":"Vakharia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Waldo R","family":"Guerrero","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shail","family":"Thanki","sequence":"additional","affiliation":[{"name":"Ochsner Lafayette General Neuroscience Center, Lafayette, LA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9519-0059","authenticated-orcid":false,"given":"Adnan H","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4270-8667","authenticated-orcid":false,"given":"Maxim","family":"Mokin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,5,13]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnis-2023-021126"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30297-1"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2019-015215"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1159\/000493022"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2015-011909"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2021-017316"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A7389"},{"key":"e_1_3_2_9_2","first-page":"159101992412303","article-title":"Experimental evaluation of the plunger technique: a method of cyclic manual aspiration thrombectomy for treatment of acute ischemic stroke","author":"Poulos DA","year":"2024","unstructured":"Poulos DA, Keith JS, Froehler MT, et al. Experimental evaluation of the plunger technique: a method of cyclic manual aspiration thrombectomy for treatment of acute ischemic stroke. Interv Neuroradiol 2024: 15910199241230364.","journal-title":"Interv Neuroradiol"},{"key":"e_1_3_2_10_2","first-page":"159101992412500","article-title":"Comparison of aspiration catheter performance using adaptive pulsatile aspiration in an in vitro thrombectomy model","author":"Silva MA","year":"2024","unstructured":"Silva MA, Sanikommu S, Bartkevitch Rodrigues P, et al. Comparison of aspiration catheter performance using adaptive pulsatile aspiration in an in vitro thrombectomy model. Interv Neuroradiol 2024: 15910199241250082.","journal-title":"Interv Neuroradiol"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.001972"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.019988"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.020315"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2013-010713"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/15910199221084481"},{"key":"e_1_3_2_16_2","first-page":"159101992312049","article-title":"The Aristotle 18 and 24 microwires in neuroIntervention: early experience at a single centre","author":"Carraro do Nascimento V","year":"2023","unstructured":"Carraro do Nascimento V, de Villiers L, Dhillon PS, et al. The Aristotle 18 and 24 microwires in neuroIntervention: early experience at a single centre. Interv Neuroradiol 2023: 15910199231204923.","journal-title":"Interv Neuroradiol"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2023.08.132"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1227\/ons.0000000000000412"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2017-013397"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnis-2024-022693"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2020-017133"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2411668"},{"key":"e_1_3_2_23_2","first-page":"159101992412789","article-title":"An in-vitro method for comparative analysis of aspiration catheter tracking performance","author":"Wodarg F","year":"2024","unstructured":"Wodarg F, Brouwer P, Power S, et al. An in-vitro method for comparative analysis of aspiration catheter tracking performance. Interv Neuroradiol 2024: 15910199241278993.","journal-title":"Interv Neuroradiol"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/1591019920982219"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2021-018318"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2024.108625"},{"key":"e_1_3_2_27_2","article-title":"Higher intracranial positioning of an 8 Fr guide catheter improves efficacy of aspiration thrombectomy in large vessel occlusion stroke","author":"Goldman D","year":"2025","unstructured":"Goldman D, Reddi P, Al-Kawaz M, et al. Higher intracranial positioning of an 8 Fr guide catheter improves efficacy of aspiration thrombectomy in large vessel occlusion stroke. 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