Pull-Through Buddy Wire Technique for Endovascular Thrombectomy in Patients with Acute Ischemic Stroke: Technical...

Area of Science:

• Neurology
• Vascular Surgery
• Interventional Radiology

Background:

• Acute large-vessel occlusion stroke treatment relies on endovascular thrombectomy.
• Vessel tortuosity, particularly in the aortic arch and carotid arteries, presents a significant challenge to successful thrombectomy.
• Current transcervical access (TCA) methods often require large punctures, increasing complication risks.

Purpose of the Study:

• To present a modified TCA technique utilizing a pull-through buddy wire (PTBW) for safe delivery of large-bore guiding sheaths (GS).
• To evaluate the feasibility and safety of this modified TCA approach in patients with challenging vascular anatomy.

Main Methods:

• A novel technique involving a PTBW to track a large-bore GS through a small carotid puncture site was developed.
• The technique was applied in two cases with significant aortic arch and left common carotid artery tortuosity.
• Carotid puncture site management was performed using gentle manual compression.

Main Results:

• Successful placement of the large-bore GS was achieved in both reported cases using the modified TCA with PTBW.
• Effective recanalization was accomplished in both patients post-GS placement.
• The small carotid puncture site was managed effectively with manual compression, minimizing local complications.

Conclusions:

• The modified TCA technique with a PTBW offers a feasible and safe approach for delivering large-bore GS in patients with tortuous cervicoaortic vasculature.
• This method potentially reduces the risks associated with traditional TCA by enabling smaller puncture sites.
• The PTBW-assisted TCA is a valuable option for improving endovascular thrombectomy outcomes in complex stroke cases.