Improving Aspiration Catheter Trackability and Navigation in Mechanical Thrombectomy: A Novel Technique Using hydrophilic 0.035 Wire.

Abstract

Background and objectives:

Aspiration catheters (Acs) have been widely used in mechanical thrombectomy. One of the main factors ensuring success is the easy navigation of the AC through the arterial anatomical challenges. In this report we describe a novel technique by advancing a hydrophilic 0.035 wire at the carotid ophthalmic segment or the vertebrobasilar junction with or without steaming of the distal end of the AC.

Material and Methods:

 We reviewed mechanical thrombectomy cases performed over an 11-month period in our institution. We specifically identified cases where the technique of advancing a hydrophilic 0.035 wire was used.  The primary endpoint was the successful advancement of the AC to the site of clot occlusion. The secondary endpoint included the occurrence of arterial dissection, perforation, or vasospasm.

Results:

A total of 82 aspiration procedures were performed for patients suffering large vessel occlusion either by aspiration only or combined with stent retrievers. The 0.035 wire was advanced without AC steaming in 29 cases or with combined use of the AC steaming and the Terumo wire as an adjuvant tool in 16 cases. The primary end point was met in 41/45 cases (91.1%). One patient experienced mechanical vasospasm (2.3%). No arterial dissection or perforation were encountered. TICI 2B-3 recanalization was achieved in 29/41 patients (70.7%) with first pass achieved in 26/41 patients (63%).

Conclusion:

Using Terumo wire 0.035 to advance ACs to the site of arterial occlusion seems an effective and safe way to improve trackability of the AC through arterial anatomical challenges.