Retriever first embolectomy (ReFirE): An alternative approach for challenging cervical access

Area of Science:

• Neuroendovascular surgery
• Cerebrovascular disease management
• Interventional neurology

Background:

• Endovascular treatment is standard for acute ischemic stroke with large artery occlusion since 2015.
• Increasing numbers of elderly patients require treatment, often presenting with difficult-to-access carotid arteries.
• Direct carotid puncture is a valuable but complication-prone technique with a learning curve.

Observation:

• A novel 'retriever first embolectomy' (ReFirE) technique was developed.
• This technique involves deploying a stent-retriever over diagnostic catheters to create a stable anchor.
• It precedes the use of larger guide and intermediate catheters for accessing intracranial vasculature.

Findings:

• The ReFirE technique was successfully applied in the first reported case.
• This approach aims to facilitate safer access to the internal carotid artery and intracranial vessels.
• The technique establishes a stable platform prior to advancing larger caliber devices.

Implications:

• The ReFirE technique may offer a safer alternative for endovascular stroke treatment in patients with challenging anatomy.
• It has the potential to reduce complications associated with direct carotid puncture.
• Further studies are warranted to evaluate the efficacy and safety profile of this novel approach.