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

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. 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. 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. 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.