Telescope-Assisted Combined Thrombectomy (TACT-MeVO) for M2 Occlusion: A Technical Note and Initial Experience.

OBJECTIVE

This study aimed to describe telescope-assisted combined thrombectomy for medium vessel occlusion (TACT-MeVO) in patients with M2 occlusion and report our initial experience.

METHODS

We retrospectively reviewed 52 thrombectomy procedures in 51 patients with M2 occlusion between May 2015 and April 2026: 45 historical-protocol and 7 TACT-MeVO procedures. In TACT-MeVO, a small-bore aspiration catheter and stent retriever are withdrawn together into a large-bore M1 aspiration catheter. Outcomes and between-group P values were exploratory and descriptive; the study was not powered to test superiority.

RESULTS

TACT-MeVO was first-line in all 7 procedures. Baseline CT-Alberta Stroke Program Early CT Score was numerically higher in the TACT-MeVO group but did not differ significantly (P = 0.069). Median puncture-to-recanalization/procedure-end time was 59 vs. 71 min (P = 0.014). One-pass completion was achieved in 6/7 (85.7%) vs. 23/45 procedures (51.1%; P = 0.117), and final modified Thrombolysis in Cerebral Infarction ≥2b in 7/7 (100%) vs. 39/45 procedures (86.7%; P = 0.580). Any subarachnoid hemorrhage occurred in 2/7 vs. 8/45 procedures (P = 0.608); both TACT-MeVO events were asymptomatic. Three-month modified Rankin Scale score 0-2 did not differ significantly (5/7 vs. 16/45; P = 0.104). A post hoc comparison with 29 procedures using conventional combined thrombectomy also showed a shorter procedural time (59 vs. 70 min; P = 0.004).

CONCLUSION

TACT-MeVO was technically feasible in this initial 7-procedure experience. Comparative findings are descriptive; superiority or safety cannot be inferred because of the small sample, baseline imbalance, and historical comparator.