Sideway Aspiration Technique for Thrombus in a Sharply Bifurcated Branch of a Large Vessel.

Abstract

Standard thrombectomy techniques, including stent retrieval and a direct aspiration first pass technique, are not effective when the occluded vessel is narrow and sharply bifurcated from the main trunk. Here, we present a new and alternative method for patients with such anatomical features and describe two cases treated by this method. Case 1 was a 66-year-old woman who presented with consciousness disturbance and left hemiparesis. MRA suggested a right middle cerebral artery occlusion. Case 2 was an 86-year-old man who presented with sudden onset of consciousness disturbance; MRA indicated occlusion of the basilar artery. Both cases were successfully treated by our new method. First, we navigated a microcatheter, microguidewire, and aspiration catheter into the patent and visible branch adjacent to the occluded branch. The aspiration catheter was then carefully pulled back with continuous mechanical aspiration. When reverse blood flow from the aspiration catheter was suspended, we slightly advanced the catheter and caught the thrombus. Complete recanalization was attained in the two cases treated with this technique, which was named as sideway aspiration technique (SAT). Although it warrants further study, SAT may be a potentially safe and effective method for thrombectomy in cases with thrombus in a sharply bifurcated branch.