Pull the Trigger Sign: A Novel Method to Identify the Clot Position during Acute Endovascular Thrombectomy

Area of Science:

• Neurology
• Interventional Radiology
• Medical Devices

Background:

• Accurate clot localization is crucial for successful endovascular mechanical thrombectomy.
• Current methods for clot identification can be imprecise, potentially delaying treatment.
• Stent retrievers and aspiration catheters are key tools in mechanical thrombectomy.

Purpose of the Study:

• To introduce and validate a new method, the Pull the Trigger Sign (PTS), for precise clot position identification.
• To assess the efficacy of PTS in facilitating safer and more efficient mechanical thrombectomy procedures.
• To improve recanalization rates and reduce procedure time in stroke treatment.

Main Methods:

• Selective angiography via microcatheter to visualize clot and distal artery.
• Observation of contrast media stagnation and subsequent washout upon stent retriever deployment.
• In vitro validation using a silicone vascular model simulating clot and blood flow.
• Clinical confirmation of PTS efficacy in real-world thrombectomy cases.

Main Results:

• The Pull the Trigger Sign (PTS) demonstrated 100% accuracy in identifying the proximal clot end in the vascular model.
• Contrast washout precisely correlated with the stent retriever reaching the clot's proximal margin.
• Clinical application confirmed PTS's utility in guiding aspiration catheter use.
• PTS led to higher first-attempt recanalization success rates and faster procedures.

Conclusions:

• The Pull the Trigger Sign (PTS) is a reliable indicator of the proximal clot end.
• PTS enables safer and more effective contact aspiration during mechanical thrombectomy.
• This novel sign improves procedural efficiency, leading to faster recanalization and better outcomes for stroke patients.