Introduction/Purpose Blind exchange with mini-pinning (BEMP) is a novel technique useful for achieving improved reperfusion rates in distal mechanical thrombectomy for acute ischemic stroke. It allows the combined use of a stentriever with a 035 distal thrombectomy catheter, whereby deployment of a stentretriever through a microcatheter and 071 thrombectomy catheter is followed by stripping of the 021 microcatheter with subsequent blind navigation of a longer 035 aspiration catheter over the stentriever wire to engage the thrombus. We report the unique use of the BEMP technique for the management of seven cases with acute middle cerebral artery occlusions.
Materials and Methods All patients undergoing BEMP for acute ischemic stroke between January and March 2023 were retrospectively identified from a prospectively maintained IRB-approved institutional database of the senior authors and analyzed.
Results Seven patients met inclusion criteria: average age 72±7.36 years-old (range 35-94 years), 43% (n=3) women. Past medical history included 5 (71%) patients with hypertension or atherosclerotic disease and 2 (29%) with diabetes mellitus. Six (86%) were taking an anticoagulant or antiplatelet medication, and 2 (29%) received tPA. Average NIHSS was 16±6. Location of occlusion included 6 (57%) in M2 branches and 1 (14%) M1 branch. The Zoom35 aspiration catheter was utilized in 6 (86%) cases of Zoom 35 and the Zoom55 in one case. Stentretrievers utilized included Trevo (4mm, 3mm, Stryker Neurovascular), Tigertriever (RapidMedical) and Solitaire (3mm, Medtronic Neurovascular). Fluoroscopy time averaged 24±4.9 minutes, with an average of 1.7±0.5 passes, and recanalization with mTICI&x2267;2b was achieved in all cases (100%). The BEMP technique was successful in all (100%) cases, with a single case of M3-M4 vasospasm noted, no other complications. Average mRS 2-weeks procedure was 3.1±0.8, with 7.4±2.8 days for length of stay.
Conclusion Blind mini-pinning allows for combined use of distal stentriever with a 035 thrombectomy catheter, affording a larger ID than traditional microcatheter engagement of the thrombus with enhanced stability for removal, and improved reperfusion rates in distal occlusions. This technique may be efficacious for the treatment of distal occlusions and further studies are needed to compare outcomes in distal occlusions.
Disclosures B. Meyer: None. J. Campos: None. D. Zarrin: None. M. Khan: None. J. Collard de Beaufort: None. G. Amin: None. K. Golshani: None. N. Beaty: 2; C; Medtronic Neurovascular, Stryker Neurovascular. 5; C; CMO of NeuroMedica. M. Bender: 2; C; Stryker Neurovascular. G. Colby: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular. L. Lin: 2; C; Medtronic Neurovascular, Stryker Neurovascular, MicroVention-Terumo, Rapid Medical, Balt. A. Coon: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular, Rapid Medical, Avail MedSystems, Imperative Care, InNeuroCo, Q’apel, Sequent Medical.
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