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Preventing vessel perforations in endovascular thrombectomy: feasibility and safety of passing the clot with a microcatheter without microwire: the wireless microcatheter technique
  1. Annika Keulers1,
  2. Omid Nikoubashman1,
  3. Anastasios Mpotsaris1,
  4. Wilson D Scott2,
  5. Martin Wiesmann1
  1. 1Department of Neuroradiology, University Hospital Aachen, Aachen, Germany
  2. 2Route 92 Medical, San Mateo, California, USA
  1. Correspondence to Professor Martin Wiesmann, Department of Neuroradiology, University Hospital Aachen, Aachen 52074, Germany; mwiesmann{at}ukaachen.de

Abstract

Background To place a stent retriever for thrombectomy in acute ischemic stroke, the clot has to be passed first. A microwire is usually used for this maneuver. As an alternative, a wireless microcatheter can be used to pass the clot.

Objective To analyze the feasibility and complication rates of passing the clot using either a microwire or a wireless microcatheter.

Methods A retrospective non-randomized analysis of 110 consecutive patients with acute ischemic stroke in the anterior circulation was performed, in whom video recordings of mechanical thrombectomies were available. In total, 203 attempts at mechanical recanalization were performed.

Results Successful recanalization (TICI 2b–3) was achieved in 97.3% of patients. In 71.8% of attempts the clot was successfully passed using a wireless microcatheter only. When a microwire was used initially, clot passage was successful in 95.3% of attempts. Complication rates for angiographically detectable subarachnoid hemorrhage were 6.1% when a microwire was used to pass the clot compared with 0% when a wireless microcatheter was used (p<0.001). Complication rates for angiographically occult circumscribed subarachnoid contrast extravasation observed on post-interventional CT scans were 18.2% when a microwire was used to pass the clot and 4.5% when a wireless microcatheter was used (p<0.001).

Conclusions In most cases of mechanical recanalization the clot can be passed with a wireless microcatheter instead of a microwire. In our study this method significantly reduced the risk for vessel perforation and subarachnoid hemorrhage. We therefore recommend the use of this technique whenever possible.

  • thrombectomy
  • stroke

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Footnotes

  • Contributors AK designed the study, collected and analysed the data, drafted and revised the manuscript, approved the final version, and agrees to be accountable for all aspects of the work. ON designed the study, drafted and revised the manuscript, approved the final version, and agrees to be accountable for all aspects of the work. AM made substantial contributions to the interpretation of data for the work, revised the draft paper, approved the final version, and agrees to be accountable for all aspects of the work. WDS made substantial contributions to the interpretation of data for the work, revised the draft paper, approved the final version, and agrees to be accountable for all aspects of the work. MW conceptualized the work, designed the study, analysed the data, drafted and revised the manuscript, approved the final version, and agrees to be accountable for all aspects of the work. He is the guarantor.

  • 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 MW reports personal fees from Stryker Neurovascular, Siemens Healthcare, Bracco Imaging, and Medtronic outside the submitted work and has received grants for educational exhibits (non-personal) from the following companies: Abbott, ab medica, Acandis, Bayer, Bracco Imaging, B Braun, Codman Neurovascular, Kaneka Pharmaceuticals, Medtronic, Dahlhausen, Microvention, Penumbra, Phenox, Philips Healthcare, Route 92, Siemens Healthcare, SilkRoad Medical, St Jude, Stryker Neurovascular. AM reports personal fees from Neuravi, Penumbra, Stryker, and Perflow outside the submitted work.

  • Patient consent Not required.

  • Ethics approval Ethics Committee, University Hospital Aachen RWTH.

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

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