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Abstract
Mechanical thrombectomy is the gold standard intervention for large vessel occlusion (LVO) ischemic stroke since the multiple positive trials in 2015. Retrieval devices are commonly used and contribute to efficacy. Microcatheter selection depends on internal diameter (ID) compatibility of the microcatheter and retrieval device. The Embolus Retriever with Interlinked Cages (ERIC™) 4 and 6 are labeled compatible with 0.021-inch minimum ID microcatheters, and ERIC™ 3 is compatible with 0.017-inch microcatheters. We report the feasibility of 0.017 and 0.0165 microcatheters for delivery of all ERIC™ devices. Materials and Methods All patients who underwent LVO thrombectomy at our institution since ERIC™ became commercially available in June 2023 were screened and their devices used were analyzed. Only patients for whom an ERIC™ was used, which was delivered using a 0.017- or a 0.0165-inch ID microcatheter were included.
Results Twenty patients met these criteria. Patient age, LVO location, number of thrombectomy passes, mTICI score, and device list are included in the following table. The images demonstrate a radiographic example of the microcatheter and embolus retriever compatibility. Notably, 13 of the 20 patients achieved TICI 2b or 3 recanalization. All three sizes of ERIC™ were utilized. Multiple 0.017 and 0.0165 ID microcatheters were used.
Conclusion Thrombectomy success in LVO stroke depends on multiple factors. Smaller microcatheters permit improved navigability and imaging quality when injecting through intermediate catheters. They may contribute to less clot disruption thus less risk for distal embolization from fragmentation. This is the first reported series ERIC™ embolus retriever delivery through microcatheters smaller than listed compatibility. This series may permit operators to select from a wider variety of compatible devices to individualize care for each stroke patient.
Disclosures A. Ho: None. B. Jagadeesan: 2; C; Microvention, Stryker, Medtronic, Boston Scientific.