Macrowire for Intracranial Thrombectomy: A Video Description

Abstract

Mechanical thrombectomy has become the cornerstone to achieve reperfusion in large vessel occlusion causing acute ischemic stroke. Since the advent of intracranial thrombectomy, the procedural setup has been to deliver aspiration catheter over microwire and microcatheter to the intracranial occlusion (ADAPT) or to deliver the stent-retriever through the microcatheter (SOLUMBRA) to perform thrombectomy.1 In both these techniques the quintessential aspect is crossing the clot/thrombus, which increases the chances of clot fragmentation or disruption.2 We demonstrate delivering an ultra-large bore (Sofia 0.088, Microvention, Aliso Viejo, CA, USA) to the intracranial occlusion over a macrowire (Aristotle Colossus OD: 0.035' × 200 cm, Scientia Vascular, UT, USA) alone with no use of microcatheter or microwire. The utilization of macrowire to perform thrombectomy provides enough support to guide the large or ultra large bore catheter to the clot interface without the need to cross the clot. As this technique involves no crossing of clot it prevents clot disruption and distal embolization. There are other possible benefits which are under study in MINT Registry3 and include making thrombectomy more time and cost efficient.