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Ischemic Stroke
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Blind exchange with mini-pinning technique for distal occlusion thrombectomy
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  • Published on: 16 March 2020
    Blind Exchange with Mini-pinning Technique: A Salvage Technique for Proximal Occlusions Inaccessible to Large-Bore aspiration Catheters
    • Mougnyan Cox, Neurointerventional Fellow Hospital of the University of Pennsylvannia
    • Other Contributors:
      • Neda I. Sedora-Roman, Attending Neurointerventional Radiologist

    Haussen et al described a technique of blind exchange with mini-pinning technique (BEMP) for distal occlusion thrombectomy. The authors are to be commended for a well-written article show-casing an important technique for reperfusing distal occlusions in eloquent territories. We recently used a variation of this technique for mechanical thrombectomy in a large proximal vessel occlusion to great effect.

    A 64-year-old man with atrial fibrillation presented to our institution with a right ICA terminus occlusion and NIHSS 17. Mechnical thrombectomy with a Solitaire retriever and 6F aspiration catheter (Solumbra technique) was attempted, but could not be performed due to marked tortuosity of the aortic arch and right cervical ICA, which prevented the aspiration catheter from reaching the clot. Two passes were attempted with the stentriever alone, without success (TICI 0). Therefore, a Trevo stentriever was advanced through the right ICA occlusion via a Markman microcatheter, the microcatheter was removed, and a 3MAX aspiration catheter was advanced over the retriever delivery wire. The stent was left in place for 5 minutes, and the thrombus was retrieved under continuous aspiration after partial ingestion/corking of the thrombus into the 3MAX aspiration catheter (BEMP). This was performed for a total of 2 passes, at the end of which there was complete revascularization of the right MCA territory (TICI 3).

    The BEMP technique described by Haussen et al is an import...

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    Conflict of Interest:
    None declared.