The mechanical thrombectomy procedures for intracranial MeVOs (medium vessel occlusions) have been developed in recent years, although the optimal approach remains unclear. This study was aimed to investigate the safety and effectiveness of mechanical thrombectomy technique in MeVOs using mini stent retrievers combined with low-profile distal aspiration catheters through the blind exchange/mini-pinning technique. A review of a well maintained database of patients was made, treated with the mini stent retriever or the BEMP technique alone for intracranial MeVOs from 2017-20 in a stroke center. Both groups were compared about baseline characteristics, procedural outcomes, clinical presentation, clot cause, occlusion site, along with safety and clinical outcomes at 90 days.

This study reviewed 102 patients/106 MeVOs treated with the mini stent retriever (n=50) or BEMP technique (n=56). A higher rate of MeVO first-pass lowered the need of rescue therapy (7.1% vs. 22%), expanded thrombolysis in cerebral ischemia 2c/3 recanalization (57% vs. 34%), lowered the rate of emboli to new territory (1.8% vs. 12%) and symptomatic intracranial hemorrhage (1.9% vs. 12.8%) with the BEMP technique. After the conduction of the multivariable analysis, the only independent factor was found to be the BEMP technique.

In  conclusion, the BEMP technique may lead to higher rates of first-pass recanalization and a lower incidence of symptomatic intracranial hemorrhage than mini stent retrievers alone, in the setting of MeVOs.