Microcatheter Aspiration Thrombectomy with a 0.025″ Microcatheter for Distal Vessel Occlusions in Acute Ischemic Stroke with Disabling Deficits.

Objectives: To evaluate the feasibility and safety of microcatheter aspiration thrombectomy (MAT) using a 0.025″ microcatheter (PX-SLIM™) for distal vessel occlusions (DVOs) in acute ischemic stroke (AIS) with disabling deficits, and to explore outcome differences between patients with and without intravenous thrombolysis (IVT).

Methods: This retrospective multicenter study included 21 highly selected AIS patients (July 2022-June 2024) with angiographically confirmed DVOs in the M3-M4, A3-A4, or P3-P4 segments. All had an Alberta Stroke Program Early CT Score (ASPECTS) of 10 and disabling deficits and underwent MAT using the PX-SLIM™ microcatheter. Outcomes included clinical scores-National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS)-angiographic reperfusion using the modified Thrombolysis in Cerebral Infarction (mTICI; success ≥ 2b), and procedural safety.

Results: 14 patients (66.7%) received IVT + MAT and 7 (33.3%) MAT alone. Successful reperfusion (mTICI ≥ 2b) was achieved in all 21 patients (100%). Median NIHSS improved from 3 at admission to 1 at discharge and 0 at 3 months. At discharge, 90.5% had an mRS of 1 and 9.5% an mRS of 2; at 3 months, 85.7% achieved mRS 0 and 14.3% mRS 1. No hemorrhage, dissection, distal embolization, or AIS recurrence occurred; transient vasospasm was observed in 38% without clinical impact.

Conclusion: MAT using the PX-SLIM™ microcatheter appears to be a technically feasible approach with an acceptable safety profile in this small, highly selected cohort. The encouraging results are exploratory, and larger prospective studies are needed to confirm these findings.