Distal thrombectomy for acute ischemic stroke: is a 0.008-inch wire a safer alternative?

Area of Science:

• Neuroendovascular therapy
• Cerebrovascular diseases
• Interventional neurology

Background:

• Distal medium vessel occlusion (DMVO) thrombectomy presents significant challenges due to complex anatomy and procedural risks.
• Existing techniques for DMVO may have limitations in terms of safety and efficacy, necessitating the exploration of novel approaches.

Purpose of the Study:

• To evaluate the efficacy and safety of employing a 0.008-inch J-shaped microguidewire for thrombectomy in patients with acute ischemic stroke (AIS) due to DMVO.
• To assess the recanalization rates and clinical outcomes associated with this specific microguidewire in DMVO treatment.

Main Methods:

• Retrospective analysis of 32 consecutive AIS patients with DMVO treated with a 0.008-inch J-shaped microguidewire at a high-volume stroke center in 2024.
• Data collected included baseline characteristics, National Institutes of Health Stroke Scale (NIHSS) scores, IV-tPA administration, occlusion location, and procedural complications.
• Successful recanalization defined as modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3; good clinical outcome defined as modified Rankin Scale (mRS) score ≤ 2 at 90 days.

Main Results:

• Successful recanalization was achieved in 90.6% of patients (n=29).
• No guidewire-related complications were reported; symptomatic intracranial hemorrhage occurred in 6.3% (n=2).
• A good clinical outcome (mRS ≤ 2) was observed in 53.1% of patients.

Conclusions:

• The use of a 0.008-inch J-shaped microguidewire appears to be a safe and effective option for DMVO thrombectomy in AIS.
• This microguidewire may offer enhanced procedural safety and success, addressing a critical need for improved distal thrombectomy techniques.
• Further prospective studies are warranted to confirm these findings and establish the role of this device in DMVO treatment.