An Alternative Side Puncture Technique for Aspiration Catheters in Mechanical Thrombectomy

Length mismatch between aspiration catheters and microcatheters can hinder optimal thrombus engagement, particularly in tortuous vessels and cases of vascular stenosis. We present a case in which a side puncture technique was used to deploy the stent retriever when exchangeable devices were unavailable. A man in his seventies with basilar artery occlusion underwent mechanical thrombectomy. The aspiration catheter failed to advance because of the tortuosity of the vertebral artery, preventing the microcatheter from delivering the stent retriever distal to the thrombus. By puncturing the aspiration catheter, additional microcatheter length was obtained, allowing the stent to be deployed at the targeted site. Thrombus extraction was then successfully performed using the Solumbra technique. This approach is advantageous for its simplicity and eliminates the need for additional devices. However, it also has specific drawbacks, such as damaging the aspiration catheters.