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. 2020 Apr;12(4):392-395.
doi: 10.1136/neurintsurg-2019-015205. Epub 2019 Aug 31.

Blind exchange with mini-pinning technique for distal occlusion thrombectomy

Diogo C Haussen  1 , Alhamza R Al-Bayati  1 , Brendan Eby  1 , Krishnan Ravindran  1 , Gabriel Martins Rodrigues  1 , Michael R Frankel  1 , Raul G Nogueira  1
Affiliations

Blind exchange with mini-pinning technique for distal occlusion thrombectomy

Diogo C Haussen et al. J Neurointerv Surg. 2020 Apr.

Abstract

Introduction: Technical improvements to enhance distal occlusion thrombectomy are desirable. We describe the blind catheter exchange technique and report the pinning technique with small devices ('mini-pinning') for distal occlusions.

Methods: A retrospective review of a prospective database from January 2015 to August 2018 was performed for cases of distal occlusion in which the 'blind exchange/mini-pinning' (BEMP) techniques were used. The technique involves the deployment of a 3 mm Trevo retriever followed by microcatheter removal and blind advancement of a 3MAX aspiration catheter over the bare retriever delivery wire ('blind exchange') until clot contact under aspiration. The retriever is subsequently partially recaptured in order to 'cork' the thrombus ('mini-pinning') and the system pulled as a unit. Patients with distal occlusions treated with BEMP and standard techniques (either 3 mm Trevo or 3MAX) were compared.

Results: Twenty-five vessels were treated in 22 patients. The majority of patients had isolated distal occlusions predominantly in the distal middle cerebral artery (MCA) segments, half of which involved the superior division. The comparison between BEMP (n=25 vessels) and standard techniques (n=144 vessels) revealed balanced groups. One of the highlighted differences was the more distal MCA occlusions among those who underwent BEMP (M3 occlusions 52% vs 22%; p=0.001). Otherwise, the vessel, segments, divisions and luminal diameter were comparable. There was a higher rate of first-pass modified Thrombolysis in Cerebral Infarction 2b-3 (80% vs 56%; p=0.03) and a trend towards higher rates of first-pass full reperfusion (60% vs 40%; p=0.07) with BEMP compared with standard techniques. Final reperfusion and clinical outcomes were comparable.

Conclusion: BEMP appears to be a safe and effective technique for the treatment of distal occlusions. Additional studies are warranted.

Keywords: stent; stroke; thrombectomy.

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Conflict of interest statement

Competing interests: ARA-B, BE, KR, GMR, MRF: none. DCH: Consultant for Stryker and Vesalio. RN: Principal Investigator, Stryker Neurovascular (DAWN trial, no compensation, Trevo‑2 trial), Cerenovus/Neuravi (ENDOLOW trial, no compensation); consultant to Stryker Neurovascular; steering committee member, Stryker Neurovascular (no compensation), Medtronic (SWIFT trial, SWIFT Prime trial, no compensation), Cerenovus/Neuravi (ARISE‑2 trial, no compensation); angiographic core lab, Medtronic (STAR trial); executive committee mem­ber, Penumbra (no compensation); physician advi­sory board, Cerenovus/Neuravi, Phenox, Anaconda, Genentech, Biogen, Prolong Pharmaceuticals, Allm Inc (no compensation), Viz-AI; stock options, Viz-AI.

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