Mechanical Thrombectomy using Distal Access Catheters: Current Status and Future Prospects

Abstract

BACKGROUND AND PURPOSE: Mechanical Thrombectomy (MT) using modern devices has proved to be efficacious in reestablishing intracranial circulation and reduced procedural times. We outline a number of endovascular techniques utilizing the distal access catheter, the circumstances where they are applicable, and the outcomes achieved. METHODS: In this review, we describe a variety of endovascular techniques with distal access catheter, deployed with and without the stent retriever device gained from our experience of performing over 700 procedures in 10 years of providing a 24/7 service within the national framework of a hyperacute stroke centre. RESULTS: We used distal access catheter techniques for intracranial support during a stent-retriever thrombectomy or thrombosuction on its own. When used as a sole suction device, or combined with a stent-retriever, we have been able to provide a rapid route to successful reperfusion, with minimal complications related to our endovascular procedures. We can report distal access catheter techniques works well when access to thrombi involves navigation through tortuous vessel anatomy, notably when convoluted loops in the cervical internal carotid artery are encountered. We suggest use of the distal access catheter techniques in thrombectomy procedures for steep-angle Middle Cerebral Artery occlusions, M2/M3 occlusion, and for basilar occlusion, where thrombectomy via suction alone proved to be adequate. CONCLUSION: In this pictorial review, we have demonstrated techniques where distal access catheter when used as a sole suction device, or combined with a stent-retriever, has been able to provide a rapid route to successful reperfusion, with minimal complications related to our endovascular procedures.

Safety Assessment of Symptomatic Intracranial Atherosclerotic Stenosis: A Comparison between Sole Balloon Angioplasty and Medical Treatment

“…Consequently, this contributes to increased procedural success rates and diminished surgical risks 15 . (2) progressive expertise of neurointerventional practitioners: In contrast to the SAMMPRIS study, which mandated that operators should possess experience with over 20 intracranial arterial stenosis surgeries 3 , the standardization of acute large-vessel occlusion endovascular treatment since the release of major studies in 2015 16 has resulted in an annual caseload exceeding 100 cases at our institution.…”

Mechanical thrombectomy using the retrograde semi-retrieval technique for patients with underlying intracranial atherosclerotic stenosis

“…This makes RESET an optimal thrombectomy procedure for ICAS patients as most ICAS patients require rescue therapy. In the majority of MCA occlusion cases, the DIC can be easily advanced to the MCA (13), facilitating the rapid exchange of the balloon or stent deployment. Fourth, the DIC is advanced close to the clot or the residual stenotic lesion, maximizing the aspiration force, reducing the clot-retrieval distance, and inhibiting thrombus migration.…”

“…Distal intracranial catheters (DICs) are widely utilized for continuous clot aspiration, owing to their exceptional efficacy in attaining high recanalization rates and reducing incidences of thrombi dislodgement (13). Previous studies have predominantly concentrated on advancing the DIC's distal end to the carotid siphon level to achieve thrombus proximity.…”