In acute ischemic stroke, patient outcomes can be improved by first-pass successful recanalization of the occluded vessel. This study investigated whether microcatheter position could influence the success of first-pass recanalization.
We retrospectively analyzed 59 consecutive acute ischemic stroke patients who underwent intra-arterial thrombectomy with stent retrievers for middle cerebral artery (M1) occlusion. Angiography findings obtained via the first pass of the microcatheter were analyzed. The microcatheter was considered to be inserted into M2 segments that gave rise to parietal arteries (M2P) if the anterior or posterior parietal artery was observed. Recanalization results were compared between patients with and without microcatheter insertion into M2P. The angle and diameter of vessels were measured using post-procedural magnetic resonance angiography (MRA).
The rate of first-pass successful recanalization (modified thrombolysis in cerebral infarction score of ≥2b) was significantly higher in patients with microcatheter insertion into M2P than in those without (56% vs 22%, p = 0.016). The number of passes was lower in patients with first-pass microcatheter insertion into M2P than in those without (1.8±1.0 vs 2.5±1.5, p = 0.05). The mean diameter of M2P was significantly larger than that of the other M2 (1.9±0.6 mm vs 1.7±0.5 mm, p = 0.035). The M1/M2P angle was significantly smaller than that between M1 and the other M2. (49±32° vs 67±31°, p = 0.006).
First-pass microcatheter insertion into M2P may contribute to fast successful recanalization in patients with M1 occlusion who undergo intra-arterial thrombectomy using stent retrievers.

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