Blind exchange technique to facilitate large-bore aspiration catheter navigation during stroke thrombectomy

Optimizing mechanical thrombectomy (MT) techniques is an essential facet of our developing field. Herein, we describe the "Blind exchange" (BE) technique; an alternative fashion of efficiently performing stent-retriever (SR) coupled with contact aspiration thrombectomy (aspiration-retriever technique for stroke-ARTS).

A prospectively collected MT database was reviewed from July 2018-February 2020. We included all consecutive patients with anterior circulation large vessel occlusions in whom BE technique was performed. According to the response of the retriever, the decision to add an aspiration catheter (AC) for ARTS was made. The microcatheter was then fully retracted and the AC tracked over the deployed SR wire in a BE fashion. The primary outcome was technical success and safety measures included procedural-related complications.

One hundred nineteen patients were identified, mean age was 66.7 ± 15.8 years and 57(47.9%) were males. Twenty-six patients (21.8%) had intracranial ICA occlusion and 93(78.2%) had MCA-M1 segment occlusion. The median ASPECTS was 7(IQR;8-9), baseline NIHSS score was 18(IQR;14-21), and procedure time was 36(IQR;25-57) minutes. IV-tPA was used in 26(21.8%) of cases. Successful reperfusion (eTICI2b-3) was achieved in 100% of cases including full reperfusion (eTICI3) in 67(56.3%) of cases. The AC was successfully navigated into the target lesion without any complications in all cases. Symptomatic intracranial hemorrhage occurred in 4.2% of patients. The rates of 90-day mRS0-2 and mortality were 44.3% and 12.5%, respectively.

BE is a safe and feasible alternative technique of navigating large bore AC into the intracranial vasculature while performing ARTS.