First-pass efficacy with simplicity: Macrowire-only direct aspiration technique in posterior circulation mechanical...

Area of Science:

• Neuroscience
• Interventional Neurology
• Medical Devices

Background:

• Mechanical thrombectomy for large-vessel occlusions faces navigation challenges due to the ledge effect.
• New large-bore macrowires offer flexibility and control, potentially overcoming these navigational difficulties.
• Evaluating the efficacy of macrowire-assisted aspiration catheters (ACs) in posterior circulation occlusions is crucial.

Purpose of the Study:

• To assess the technical feasibility of delivering large-bore aspiration catheters (ACs) to posterior circulation occlusions.
• To evaluate the Macrowire-Only Direct Aspiration First-Pass Technique (MO-ADAPT) for treating posterior circulation strokes.
• To determine the procedural success and complication rates associated with MO-ADAPT.

Main Methods:

• Retrospective multicenter study of 42 patients with posterior circulation strokes.
• Utilized adjunct-free MO-ADAPT with 0.024- and 0.035-inch macrowires.
• Primary outcomes: successful AC delivery, successful MO-ADAPT, and first-pass reperfusion (modified thrombolysis in cerebral infarction [mTICI] score ≥ 2b).

Main Results:

• Successful adjunct-free AC delivery to the occlusion was achieved in 95.2% of patients.
• MO-ADAPT achieved successful reperfusion in 81.0%, with 54.8% achieving first-pass reperfusion.
• Low rates of vascular complications (0%), postprocedural intracranial hemorrhage (2.4%), and distal emboli (2.4%) were observed.

Conclusions:

• MO-ADAPT appears technically feasible for posterior circulation strokes, demonstrating promising procedural outcomes and a low complication profile.
• Underlying intracranial atherosclerotic disease was identified as a negative predictor for MO-ADAPT and first-pass reperfusion success.
• Further large-scale, comparative studies are warranted to establish the definitive safety, efficacy, and cost-effectiveness of MO-ADAPT.