Multiple recent randomized controlled trials have proven the benefit of mechanical thrombectomy using stent retrievers for emergent large vessel occlusion (ELVO).1–5 Techniques currently used for endovascular treatment of stroke employ either direct aspiration, stent retriever thrombectomy or a combination of both. When stent retrievers are used, temporary flow arrest with an extracranial balloon guide catheter or assisted local aspiration with a large bore intracranial suction catheter is recommended. This allows for more complete recanalization and prevents embolization to previously uninvolved territories. Recent advancements in large bore intracranial suction catheter technology have made it easier to utilize coaxial stent retriever thrombectomy assisted by local aspiration. At our high-volume comprehensive stroke center, we have found the second generation large bore intracranial Arc support catheter (ev3 Neurovascular, Irvine, CA) to be extremely effective when used in combination with the Solitaire stent retriever (ev3 Neurovascular, Irvine, CA). We have found the Arc support catheter to be much more navigable, less prone to kinking and easier to deliver into the M1 segment (without causing spasm) than the first generation local aspiration catheters. Additionally, the Arc support catheter is less costly than the currently available suction catheters. The Sol-Arc technique begins with placement of a stent retriever device across the embolic occlusion by deployment though a 021 or 027 microcatheter. This microcatheter is placed coaxially through the Arc support catheter which is positioned just proximal to the embolus. After waiting 5 minutes, the stent retriever is pulled inside the Arc support catheter which is simultaneously aspirated. Subsequently, the Arc support catheter is removed while aspirating the guiding sheath in the neck. This technique should allow for faster, safer and more successful stent retriever thrombectomy when used in conjunction with local aspiration.
Disclosures A. Onofrio: None. A. Miller: None. J. Hise: None. I. Thacker: None. J. Haithcock: None. D. Graybeal: None. K. Layton: None.
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