Turkish Neurosurgery
Feasibility of Distal Mechanical Thrombectomy in M3, A3, and P3 Segments via a 0.013-Inch Delivery System: Preliminary Experience
Yilmaz Onal1, Murat Velioglu1, Ugur Demir1, Erhan Celikoglu2, Hakki M. Karakas1
1Fatih Sultan Mehmet Training and Research Hospital, Radiology, Istanbul,
2Fatih Sultan Mehmet Training and Research Hospital, Neurosurgery, Istanbul,
DOI: 10.5137/1019-5149.JTN.30083-20.2

Aim:The cerebral territories supplied by distal vessels, although relatively small, can be remarkably eloquent. It is unclear whether mechanical thrombectomy should be performed in the distal vasculature. This study aimed to assess the safety and efficacy of distal thrombectomy (DT) using a Catch View mini (CVm) device via a microcatheter with a 0.013-inch inner diameter.Material and Methods:Nine of 246 acute ischemic stroke patients who underwent mechanical thrombectomy developed distal emboli and were included in the study. In all nine subjects (mean age, 64.5 ± 11.6; range, 39−77 years), a combination of CVm and a 0.013-inch microcatheter was used in distal mechanical thrombectomy. Modified Thrombolysis in Cerebral Ischemia scores of 2c and 3 were considered to indicate successful recanalization, and patients with a Modified Rankin Score of ≤ 2 on the 90th day were considered to have good clinical outcomes.Results:Eleven DT maneuvers were performed using the same stent retriever and microcatheter. The mean National Institutes of Health Stroke Scale score was 13 ± 3.4. Thrombectomy was performed from M3 in six patients, A3 in four, and P3 in one. Successful recanalization was achieved in all of the procedures. The rate of good clinical outcome was 55.5%.Conclusion:Advances in technology in the endovascular field enable access to more distal vessels in acute ischemic stroke. As the profile of the instruments used during access decreases, the risk of complications may decrease. The CVm stent retriever could become a useful tool in DT based on its compatibility with a 0.013-inch lumen delivery system.

Corresponding author : Murat Velioglu