Soft partial release of non-aggressive stent retriever technique for very distal arterial occlusion stroke.

Background: Endovascular thrombectomy (EVT) for very distal vessel occlusion (DVO) stroke is increasingly performed but there is insufficient evidence on the efficacy and safety of distal EVT techniques. We hypothesized that the technique of soft partial release of non-aggressive stent retrievers (SPORNS) reduces friction on the perforating vessels during thrombectomy and thereby reduces bleeding complications.

Methods: Retrospective study including consecutive DVO patients who were treated with the SPORNS technique between 1 January 2022 and 31 December 2022 at two tertiary stroke centers. DVOs were defined as isolated occlusions of the M3 and M4 segments of the middle cerebral artery, occlusions of the A2 and A3 segments of the anterior cerebral artery, and occlusions of the P2 and P3 segments of the posterior cerebral artery or of the superior cerebellar artery. The technique is described in detail and procedural and clinical outcomes are given.

Results: Twenty-four patients were treated with the SPORNS technique of whom 22 (92%) had complete or near complete recanalization (eTICI 2c/3). National Institutes of Health Stroke Scale (NIHSS) decreased from a median of nine (IQR 7-13) at admission to three (1-5) at discharge and 18 patients (75%) achieved a good outcome (modified Rankin scale 0-2) at day 90 post-stroke. Two patients (8%) had a small subarachnoid hemorrhage and two patients (8%) had a symptomatic intracerebral hemorrhage on follow-up imaging.

Conclusion: For the treatment of very distal arterial occlusions, the SPORNS technique employing a soft partial release of a non-aggressive stent retriever is safe and effective for the thrombectomy of small clots. The technique potentially yields a lower rate of subarachnoid hemorrhages while achieving an excellent rate of complete and first-pass recanalization.