Introduction Endovascular thrombectomy (EVT) for very distal vessel occlusion (DVO) stroke is increasingly performed but there is insufficient evidence on efficacy and safety of distal EVT techniques.

Aim of Study We evaluated a technique of soft partial release for non-aggressive stent retriever to reduce friction on perforating vessels to minimize bleeding complications.

Methods Retrospective study including consecutive DVO patients who were treated with the SPORNS-technique between January 1^st2022 and December 31^st2022 at two tertiary stroke centers. DVOs were defined as isolated occlusions of the M3 and M4-segment of the middle cerebral artery, occlusions of the A2 and A3-segment of the anterior cerebral artery, and occlusions of the P1, P2-and P3-segment of the posterior cerebral artery or of the superior cerebellar artery (SCA). The SPORNS-technique is described in detail and procedural and clinical outcomes are given.

Results 54 Patients were treated using SPORNS-technique of whom 50 (92%) had complete or near complete recanalization (eTICI 2c/3). NIHSS decreased from median 9 (IQR 7-13) to 3 (1-5) at admission and 41 patients (75%) achieved a good outcome (modified Rankin Scale 0-2) at day 90 post stroke. 4 patients (8%) had a small subarachnoid hemorrhage and 1 patients (4%) a symptomatic intracerebral hemorrhage on follow-up imaging.

Conclusion For treatment of very distal arterial occlusions, the SPORNS- technique (soft partial release for non-aggressive stent retriever) is a safe and effective technique for thrombectomy of small clots. This technique potentially yields a lower rate of subarachnoid hemorrhages while achieving an excellent rate of complete and first pass recanalization.

Disclosure of Interest no.