SNAKE-71: wire-free direct aspiration thrombectomy using the Cereglide 71 catheter for acute large vessel occlusion...

Direct aspiration has become a first-line strategy in mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke. Advances in large-bore aspiration catheters have enabled wire-free navigation techniques such as SNAKE; however, data on newer 0.071″ platforms remain limited. To evaluate the technical feasibility, angiographic efficacy, and clinical outcomes of the wire-free SNAKE technique using the Cereglide 71 aspiration catheter in acute anterior circulation LVO. Fourteen consecutive patients with acute anterior circulation LVO underwent MT using a direct aspiration-first strategy. The Cereglide 71 catheter was advanced without a microguidewire or microcatheter, following the SNAKE technique. Primary outcomes included successful reperfusion (TICI 2b-3) and first-pass effect (FPE). Secondary outcomes included procedural time, complications, NIHSS improvement, and 90-day modified Rankin Scale (mRS). Successful reperfusion was achieved in all patients (100%). First-pass effect occurred in 57.1% of cases. Mean procedural time was 12.1 ± 5.8 min with a median of one device pass. Median NIHSS improved from 19.5 at admission to 2.0 at 24 h. At 90 days, 78.6% of patients achieved functional independence (mRS 0-2). Distal embolization occurred in 42.9% of cases; however, final reperfusion was maintained in all patients. Wire-free SNAKE thrombectomy using the Cereglide 71 catheter is technically feasible and highly effective, achieving rapid reperfusion and favorable clinical outcomes. This approach represents a viable minimalist aspiration strategy in contemporary MT practice.