Introduction/Purpose Recent data suggests that endovascular thrombectomy (EVT) may be beneficial in patients with acute ischemic stroke from distal vessel occlusion (DVO). The purpose of this study is to assess safety and efficacy of primary aspiration technique in patients with DVO.

Materials and Methods This is a retrospective review of prospectively collected data of acute stroke patients at three institutions with DVO who underwent EVT between January 2021 and December 2022 with aspiration technique using Zoom catheters (0.071, 0.045, 0.055, and 0.035). DVO was defined as occlusion of mid and distal M2 or M3 segments of the middle cerebral artery, posterior cerebral artery, or anterior cerebral artery. The size of aspiration catheter was selected at the discretion of the primary interventionalist. Primary outcome measures included successful reperfusion (defined as TICI 2B or higher), number of passes, groin to recanalization time, and first pass effect. Secondary outcome measures included symptomatic intracranial hemorrhage (defined by ECASS II criteria), 90-day Modified Rankin Scale, and discharge NIHSS.

Results A total of 50 patients (52% female, median age 67y (Interquartile range (IQR) 58-78)) with DVO who underwent EVT with aspiration technique were identified. Median presenting NIHSS was 11.5 (IQR 7-17). Location of occlusion included mid M2 (n=19, 38%), distal M2 (n=14, 28%), M3 (n=9, 18%), ACA (n=5, 10%), and PCA (n=3, 6%). Primary aspiration catheters utilized included Zoom 0.045 (n=16, 32.6%), Zoom 0.035 (n=12, 24.5%), Zoom 0.055 (n=12, 24.5%), and Zoom 0.071 (n=9, 18.4%). Successful recanalization was achieved in 49 (98%) patients. Median arterial puncture to final recanalization time was 24 minutes (IQR 14-37). Median number of passes was 1.5 [IQR 1-2]. First pass effect was achieved in 23 (50%) patients. Discharge NIHSS was available for 36/50 patients of which median discharge NIHSS was 3 (IQR 0.5-6.5). Only 1 (2%) patient experienced a symptomatic ICH.

Conclusion Our findings suggest that aspiration thrombectomy with asymmetric clot engagement is safe and highly effective in patients with stroke from DVO.

Disclosures D. Goldman: None. M. Al-Kawaz: None. V. Nguyen: None. J. Dallas: None. K. Khatibi: None. J. Scaggiante: None. K. Yaeger: None. T. Hardigan: None. C. Kellner: 1; C; Penumbra, Siemens. J. Fifi: 1; C; Stryker, Penumbra. 2; C; Stryker, Microvention, Penumbra, Cerenovus. 4; C; Endostream. S. Majidi: 2; C; Rapid Medical, Imperative Care, Cerenovus.