Mechanical Thrombectomy in Medium Vessel Occlusions: Blind Exchange With Mini-Pinning Technique Versus Mini Stent Retriever Alone.
BACKGROUND AND PURPOSE
Mechanical thrombectomy techniques for intracranial medium vessel occlusions (MeVOs) have evolved in recent years, although the optimal approach is still unclear. The aim of this study was to investigate the effectiveness and safety of mechanical thrombectomy in MeVOs using mini (0.017 inches microcatheter compatible) stent retrievers combined with low-profile (0.035 inches distal inner diameter) distal aspiration catheters through the blind exchange/mini-pinning (BEMP) technique compared with mini stent retrievers alone.


METHODS
Retrospective review of a prospectively maintained database of patients treated with the BEMP technique or mini stent retriever alone for intracranial MeVOs from 2017 to 2020 in a comprehensive stroke center. Both groups were compared about baseline characteristics, occlusion site, clinical presentation, clot cause, procedural outcomes (MeVO first-pass and final expanded Thrombolysis in Cerebral Ischemia score, the mini stent retriever used, number of passes with the front-line approach, and need of rescue therapy), safety outcomes (emboli to unwanted territories and hemorrhagic complications), and clinical outcomes at 90 days. Multivariable logistic regression analysis was performed with potential predictors of vessel recanalization to find independent variables associated with MeVO first-pass expanded Thrombolysis in Cerebral Ischemia 2c/3 recanalization.


RESULTS
We reviewed 102 patients/106 MeVOs treated with the BEMP technique (n=56) or mini stent retriever (n=50). There was a higher rate of MeVO first-pass expanded Thrombolysis in Cerebral Ischemia 2c/3 recanalization (57% versus 34%, P=0.017), lower need of rescue therapy (7.1% versus 22%, P=0.028), and lower rate of emboli to new territory (1.8% versus 12%, P=0.035) and symptomatic intracranial hemorrhage (1.9% versus 12.8%, P=0.038) with the BEMP technique. After multivariable analysis, the sole independent factor associated to MeVO first-pass expanded Thrombolysis in Cerebral Ischemia 2c/3 recanalization was the BEMP technique (odds ratio, 2.72 [95% CI, 1.19-6.22]; P=0.018).


CONCLUSIONS
In the setting of MeVOs, the BEMP technique may lead to higher rates of the first-pass recanalization and a lower incidence of symptomatic intracranial hemorrhage than mini stent retrievers alone.
['Pérez-García|Carlos|C|', 'Moreu|Manuel|M|', 'Rosati|Santiago|S|', 'Simal|Patricia|P|', 'Egido|Jose Antonio|JA|', 'Gomez-Escalonilla|Carlos|C|', 'Arrazola|Juan|J|']
D000368:Aged D000369:Aged, 80 and over D005260:Female D006801:Humans D020243:Infarction, Anterior Cerebral Artery D020244:Infarction, Middle Cerebral Artery D020762:Infarction, Posterior Cerebral Artery D020300:Intracranial Hemorrhages D000083242:Ischemic Stroke D016015:Logistic Models D008297:Male D008875:Middle Aged D015999:Multivariate Analysis D011183:Postoperative Complications D012189:Retrospective Studies D017131:Thrombectomy D016896:Treatment Outcome
thrombectomy stents catheters intracranial hemorrhages incidence