Abstract 047: Solumbra ‘PINCHING’ technique for medium vessel occlusions (MeVOs): A Single Center Experience

Introduction Various techniques have been evolved and used by different operators for mechanical thrombectomies for improved procedural performance, lower intraoperative times and better recanalization rates The widely used, isolated stent‐retriever and contact aspiration technique for medium vessel occlusions (MeVOs) carries a high risk for clot fragmentation, spasm and distal migration. The stent–aspiration (Solumbra) technique uses a large bore aspiration catheter with a stent retriever device for potential synergistic effects. However, its use is limited in distal thrombectomies. Hereby, we assess the efficacy and safety of solumbra ‘Pinching’ technique by using a smaller profile aspiration catheter for MeVO thrombectomy. Methods We retrospectively analyzed our prospective institutional database for medium vessel occlusions (M2, M3 MCA/ A2, A3 ACA/ P2 PCA) who underwent endovascular mechanical thrombectomy using stent retriever or aspiration or combined (solumbra) technique. The technique involves deploying a stent retriever through microcatheter and large bore aspiration catheter like ACE 68 (Penumbra, Inc.), followed by both microcatheter and aspiration removal, clot localization and blind navigation of a correctly sized lower profile (3MAX or 4MAX, Penumbra, Inc.) aspiration catheter over stent bare wire to “pinch” the primal end of the clot. Besides various demographic parameters, we collected final recanalization rates with first pass effect [using modified Thrombolysis in Cerebral Infarction (TICI) score]. All the intra‐procedural complications (haemorrhage, vasospasm) were analysed. Clinical outcome was analysed using modified ranking score (mRS) on 7th day post procedure/ discharge(whichever is earlier) and at 90 days. Results Total 26 MeVOs were successfully treated in twenty‐five patients with solumbra ‘Pinching’ technique since January 2022 (Male: female 16:7, mean age 58.6 years, mean NIHSS 9.1). Majority of the procedures were done for primary MeVOs and 72% consisted of M2 MCA occlusions. Whether to use a 3MAX or 4MAX aspiration catheter was determined by eyeballing the appropriate calibre for target vessels. Final first pass mTICI 2c/3 recanalization was achieved in 24 patients (88%). Minor Intra‐procedural complications were observed in 13 patients. Favorable modified ranking score (mRS 0‐2) was achieved in approximately 80% patients at the end of 7 days/discharge and 14 out of 16 follow up patients achieved good clinical outcome at 90 days Conclusion Solumbra ‘Pinching’ technique, using a low profile aspiration catheter like 3 MAX or 4 MAX (Penumbra, Inc.) with a stent retriever, can be effectively used in management of acute ischaemic stroke secondary to a MeVOs with significantly enhancing the first‐pass recanalization with lesser risk of intimal injury, dissection and secondary embolization.