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1. Introduction
After the large intravenous thrombolysis trials have shown that the effectiveness of IV rTPA is limited especially in severe stroke due to large vessel occlusion, mechanical thrombectomy (MTE) has become the focus of a number of trials leading to the approval of dedicated thrombectomy systems such as the Merci retriever and the Penumbra aspiration thrombectomy system [1–3]. In addition to FDA-approved systems, a number of MTE systems have become available under CE mark over the past 3 years. One of these systems is the phenox clot retriever (phenox GmbH, Bochum, Germany). Licensed under CE mark in November, 2006, it essentially resembles a microbrush that is delivered and released through a microcatheter and then withdrawn into an aspiration catheter—either guiding or distal access. Available in three different sizes, it can be used in vessel diameters between 1 and 6 mm. By design, it offers the unique possibility to use two devices simultaneously, for example, in cases of a bifurcation occlusion. In this retrospective study, we analyzed our experience with the phenox clot retriever as part of a multimodal thrombectomy approach in acute ischemic stroke.
2. Material and Methods
56 patients with acute ischemic stroke in the anterior and/or posterior circulation were treated with the Phenox clot retriever as the sole device or as part of a multimodality strategy in combination with other devices between 01/2007 and 08/2010. Treatment was initiated within 6 hours of symptom onset for the anterior circulation and 8 hours for the posterior circulation. Neurological evaluation (NIHSS, mRS) was performed on admission and at discharge. All patients underwent CT and CTA on admission to rule out hemorrhage and to evaluate vessel occlusion. Unenhanced CT was repeated 18 h later (±6 h) and at discharge.
According to institutional guidelines, all patients who presented with symptom onset ≤3 h due to large artery occlusion received IV rtPA immediately after the CT scan while being transferred to our angiography suite for subsequent MTE. All except one procedures were performed under general anaesthesia and were carried out by a constant team of three neuroradiologists. IV lysis was stopped when the guiding catheter was positioned. If necessary, the remaining dose, up to a maximum of 0,9 mg/kg bodyweight and a total of 90 mg, was administered i.a. via a microcatheter. In case...