Two patients, separated by 1 year, underwent mechanical thrombectomy using next generation, highly navigable 0.088-inch large bore catheters, which were navigated to and aspirated within the M1 middle cerebral artery segment. Case 1 demonstrates the first reported clinical application of this technique used in conjunction with stent retriever and direct aspiration through an intermediate catheter, resulting in modified thrombolysis in cerebral infarction (mTICI) score 3 recanalisation, and a 90-day modified Rankin Score of 1. In case 2, direct on-clot aspiration was applied through a 0.088-inch guide catheter in the left M1 segment, resulting in mTICI score 3 recanalisation and a National Institutes of Health Stroke Scale score of 1 at discharge. There was no evidence of untoward events in either case. Advancement of a 0.088-inch catheter into the M1 segment offers potential benefits to thrombectomy by improving device-thrombus interaction, inducing local flow arrest and protecting proximal vessels from embolus to new territories.
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Contributors BSG, DVB, TS, SM and RDL have substantially contributed to the conception, acquisition and analysis of data for this work. BSG, DVB, TS, SM and RDL have assisted in drafting and revising the work. BSG, DVB, TS, SM and RDL have provided final approval for this version to be published. Finally, BSG, DVB, TS, SM and RDL have acknowledged and maintain the integrity of the work investigated.
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 RDL is a consultant for Imperative Care and will be the national principal investigator for an upcoming randomised controlled trial.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer-reviewed.
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