Distal thrombectomy for acute ischemic stroke: Is a 0.008-inch wire a safer alternative?

Background: Distal medium vessel occlusion (DMVO) thrombectomy remains challenging due to anatomical constraints and procedural risks. We evaluated the efficacy and safety of using a 0.008-inch J-shaped microguidewire in acute ischemic stroke (AIS) patients with DMVO. Methods: We retrospectively analyzed AIS patients who underwent DMVO thrombectomy using a 0.008-inch J-shaped microguidewire at a high-volume stroke center in 2024. Baseline characteristics, National Institutes of Health Stroke Scale (NIHSS), IV-tPA administration, occlusion location, and procedural complications were recorded. Successful recanalization was defined as modified Thrombolysis in Cerebral Infarction (mTICI) 2c–3, while good clinical outcome was defined as a modified Rankin Scale (mRS) score of ≤2 at 90 days. Results: Among 441 AIS patients treated with thrombectomy in 2024, 84 had DMVO, and 32 consecutive patients met the inclusion criteria (mean age 75±12 years, range 32–93). Primary DMVO was identified in 19 cases, while 13 had secondary DMVO following proximal thrombectomy. The mean NIHSS was 11±3.4 (range 7–21). The occlusion sites were M2 (n=21), A3 (n=6), M3 (n=4), P2 (n=2), and M4 (n=1) segments. Successful recanalization was achieved in 90.6% (n=29), with one patient requiring rescue stenting. No guidewire-related complications occurred. Symptomatic intracranial hemorrhage was observed in 6.3% (n=2), one of whom underwent decompression. The rate of good clinical outcomes was 53.1%, and 3 patients (9.3%) died. Conclusions: Neurointerventionalists are looking for better techniques to reduce the risks associated with distal thrombectomy. Our findings suggest that using a 0.008-inch J-shaped microguidewire may enhance procedural safety and success in DMVO.