Mechanical Thrombectomy using Distal Access Catheters: Current Status and Future Prospects.

BACKGROUND AND PURPOSE Mechanical Thrombectomy (MT) using modern devices has proved to be efficacious in re-establishing intracranial circulation and reduced procedural times. We outline a number of endovascular techniques utilizing the distal access catheter, the circumstances where they are applicable, and the outcomes achieved. METHODS In this review, we describe a variety of endovascular techniques with distal access catheter, deployed with and without the stent retriever device gained from our experience of performing over 700 procedures in 10 years of providing a 24/7 service within the national framework of a hyperacute stroke centre. RESULTS We used distal access catheter techniques for intracranial support during a stent-retriever thrombectomy or thrombo-suction on its own. When used as a sole suction device, or combined with a stent-retriever, we have been able to provide a rapid route to successful reperfusion, with minimal complications related to our endovascular procedures. We can report distal access catheter techniques works well when access to thrombi involves navigation through tortuous vessel anatomy, notably when convoluted loops in the cervical internal carotid artery are encountered. We suggest use of the distal access catheter techniques in thrombectomy procedures for steep-angle Middle Cerebral Artery occlusions, M2/M3 occlusion, and for basilar occlusion, where thrombectomy via suction alone proved to be adequate. CONCLUSION In this pictorial review, we have demonstrated techniques where distal access catheter when used as a sole suction device, or combined with a stent-retriever, has been able to provide a rapid route to successful reperfusion, with minimal complications related to our endovascular procedures.