Table 1

Phases of the mechanical thrombectomy procedure, with the beginning and end of each phase clearly defined

Procedure phaseTitlePhase
begins and ends
IFemoral access to descending aortaBeginsFemoral arterial access (as per institutional protocol)—wire enters the groin
EndsWire at mid thoracic aorta T5–8, above celiac trunk below origin of left subclavian
IIaManipulation in the aortic arch using a multipurpose catheter (MPA, MPB, MPC, VER, BER,…)BeginsWire advances beyond mid thoracic aorta
EndsTip of the select catheter is immediately proximal to brachiocephalic trunk
IIbManipulation in the aortic arch using a Simmons catheter (SIM1, SIM2, SIM3, VTK,…)BeginsWire advances beyond mid thoracic aorta
EndsTip of the selected catheter is immediately proximal to brachiocephalic trunk
IIIAccess from aortic arch to common carotid arteryBeginsRemoval of guidewire and acquisition of roadmap image
EndsRe-evaluation by contrast injection through select catheter positioned in the ICA
IVAdvancement and stable positioning of sheath/BGCBeginsAdvancement of BGC into ICA over select catheter.
EndsAcquisition of iso-centered biplane angiogram of intracranial vessels
VTri-axial access to and crossing of thrombusBeginsShaping distal microwire tip to facilitate atraumatic navigation
EndsRetrieving microwire from correctly positioned microcatheter
VIDeployment of stentrieverBeginsStentriever introduced to microcatheter hub
EndsStentriever fully unsheathed
VIIRetrieval of thrombusBeginsReducing tension on DAC until tip starts to retract
EndsDeflation of BGC
VIIIAngiographic control of success of retrievalBeginsRetraction of DAC to proximal ICA (below petrous segment, above CCA bifurcation)
EndsRecanalization confirmed on DSA
IXFull head control angiogramBeginsRemove DAC
EndsControl angio of cervical carotid through BGC in proximal CCA
XSafe removal of devices (as unit), access vessel closureBeginsRetraction and removal of devices
EndsArterial access closure (according to institutional protocol)
  • Ber, Berenstein catheter; BGC, balloon guide catheter; CCA, common carotid artery; DAC, distal access/aspiration catheter; ICA, internal carotid artery; MPA, multipurpose A; MPB, multipurpose B; MPC, multipurpose C.