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Macrowire for Intracranial Thrombectomy: A Video Description.

Arjun B Kumar1, Usama Khan1, Kaustubh Limaye2

  • 1Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.

Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences
|December 18, 2024
PubMed
Summary

This study introduces a novel mechanical thrombectomy technique for acute ischemic stroke, utilizing a macrowire to guide large catheters directly to the clot. This approach avoids crossing the clot, potentially reducing fragmentation and distal embolization.

Keywords:
Strokethrombectomythrombectomy technique

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Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Medical Devices

Background:

  • Mechanical thrombectomy is standard for acute ischemic stroke with large vessel occlusion.
  • Current techniques (ADAPT, SOLUMBRA) involve crossing the clot, risking fragmentation and embolization.

Purpose of the Study:

  • To present a novel mechanical thrombectomy technique using a macrowire without a microcatheter or microwire.
  • To evaluate the feasibility of delivering an ultra-large bore catheter directly to the occlusion.

Main Methods:

  • An ultra-large bore catheter (Sofia 0.088) was delivered over a macrowire (Aristotle Colossus) to the intracranial occlusion.
  • The technique bypasses the need to cross the clot with guidewires or microcatheters.

Main Results:

  • Successful delivery of the ultra-large bore catheter to the occlusion site was demonstrated.
  • The macrowire provided adequate support for catheter navigation.
  • The technique avoids crossing the clot, preventing potential clot disruption and distal embolization.

Conclusions:

  • This macrowire-guided thrombectomy technique offers a promising alternative for acute ischemic stroke.
  • Potential benefits include reduced clot fragmentation, distal embolization, and improved time/cost efficiency, currently under investigation in the MINT Registry.