Optimal pinching technique for recanalization: A retrospective analysis of mechanical thrombectomy in a 3D vessel model

Abstract

Objective

Achieving recanalization with the few passes as possible is essential for favorable outcomes in mechanical thrombectomy (MT). However, when recanalization fails, the underlying reasons often remain unclear because device–thrombus interactions cannot be directly visualized during the procedure. We investigated how device maneuver during the pinching technique influences first pass recanalization (FPR).

Methods

Using a 3D silicone cerebrovascular model and swine thrombi, 109 MT procedures were performed by experienced neurointerventionalists under clinical use fluoroscopy, blinded to direct visualization. Real-world procedural videos were retrospectively analyzed to assess the impact of device maneuvers on FPR.

Results

The pinching technique for non-segmented thrombus was applied in 58 cases. Advancing the aspiration catheter (AC) to achieve thrombus contact occurred in 52 cases, yielding FPR in 44 cases. Pulling the stent retriever (SR) toward the AC after contact was performed in 14 cases, all achieving FPR, compared with 32 of 44 cases without this maneuver. SR deployment after AC–thrombus contact frequently caused proximal AC displacement and loss of thrombus contact.

Conclusion

In pinching technique, advancing the AC to ensure thrombus contact, followed by pulling the SR toward the AC before system retrieval, may prevent stretching, facilitate effective pinching, and improve the likelihood of achieving FPR.