Background and Aims

The availability of advanced large-bore diameter aspiration catheters has improved recanalization rates and time. We report a prospectively collected clinical experience with a simple technique: MAC (Manual Aspiration Contrast Enhancement) as the primary method for vessel recanalization.

Gently contrast injection while the aspiration catheter is advanced to the thrombus and subsequently creating a closed-loop system with the contrast column within the catheter can result in better visualization during the aspiration, thus improving the FPE avoiding clot fragmentation, multiple passes and blind movements of catheter by a single operator.

Methods

47 prospectively patients with ELVO and 3 cases of middle vessel occlusion (MVO) at four institutions were included in the study. The MAC technique was utilized in all patients. Procedural and clinical data were analyzed.

Results

MAC technique using SOFIA 6 Plus Catheter was successful in achieving first pass effect (FPE) and Thrombolysis in Cerebral Infarction (TICI) 2b- 3 revascularizations in 77% of cases. The average time from groin puncture to at least TICI 2b recanalization was 16 min. National Institutes of Health Stroke Scale (NIHSS) score average at onset of 16, and improved to a median NIHSS score at discharge of 5.5. One ICA rupture and two symptomatic intracerebral hemorrhages were recorded peri operatively.

Conclusions

MAC technique is a simple, fast, safe, and effective method that has reduced the requirements to multiple passes and also avoiding the use of expensive materials to reach the occlusion site. MAC is a replicable approach without additional training requirements.