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Case report
Republished: First clinical report of aspiration through a novel 0.088-inch catheter positioned in the M1 middle cerebral artery for ELVO thrombectomy
  1. Blake S Gershon1,2,
  2. Devin V Bageac2,
  3. Tomoyoshi Shigematsu2,3,
  4. Shahram Majidi2,
  5. Reade De Leacy2
  1. 1 College of Medicine, SUNY Downstate, Brooklyn, New York, USA
  2. 2 Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  3. 3 Department of Neurosurgery, Osaka University Faculty of Medicine Graduate School of Medicine, Suita, Japan
  1. Correspondence to Dr Reade De Leacy, Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; reade.deleacy{at}


Two patients, separated by 1 year, underwent mechanical thrombectomy using next generation, highly navigable 0.088-inch large bore catheters, which were navigated to and aspirated within the M1 middle cerebral artery segment. Case 1 demonstrates the first reported clinical application of this technique used in conjunction with stent retriever and direct aspiration through an intermediate catheter, resulting in modified thrombolysis in cerebral infarction (mTICI) score 3 recanalisation, and a 90-day modified Rankin Score of 1. In case 2, direct on-clot aspiration was applied through a 0.088-inch guide catheter in the left M1 segment, resulting in mTICI score 3 recanalisation and a National Institutes of Health Stroke Scale score of 1 at discharge. There was no evidence of untoward events in either case. Advancement of a 0.088-inch catheter into the M1 segment offers potential benefits to thrombectomy by improving device-thrombus interaction, inducing local flow arrest and protecting proximal vessels from embolus to new territories.

  • thrombectomy
  • technique
  • device

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  • Republishing Republished with permission from BMJ Case Reports. Published 08/10/2020; doi: 10.1136/bcr-2020-016780

  • Twitter @rdeleacymd

  • Presented at Republished with permission from BMJ Case Reports. Published 08 October 2020; doi:10.1136/bcr-2020-016780.

  • Contributors BSG, DVB, TS, SM and RDL have substantially contributed to the conception, acquisition and analysis of data for this work. BSG, DVB, TS, SM and RDL have assisted in drafting and revising the work. BSG, DVB, TS, SM and RDL have provided final approval for this version to be published. Finally, BSG, DVB, TS, SM and RDL have acknowledged and maintain the integrity of the work investigated.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RDL is a consultant for Imperative Care and will be the national principal investigator for an upcoming randomised controlled trial.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer-reviewed.