Fig 1.
Distal access catheter (DAC) tip position during combined stent-retriever and aspiration technique in the distal DAC group.
(A, B) Left anteroposterior (A) and lateral (B) internal carotid artery angiogram images show occlusion of the left middle cerebral artery (arrowheads). (C, D) The DAC was advanced as close to the proximal end of the thrombus as possible in the middle cerebral artery (arrows).
Fig 2.
Distal access catheter (DAC) tip position during combined stent-retriever and aspiration technique in the proximal DAC group.
(A, B) Right anteroposterior (A) and lateral (B) internal carotid artery angiogram images show occlusion of the right middle cerebral artery (arrowheads). (C, D) The DAC was placed in the cavernous ICA below the ophthalmic artery origin (arrows).
Table 1.
Comparison of the baseline characteristics according to the DAC tip position.
Table 2.
Comparison of the outcomes between the distal and proximal DAC groups.
Fig 3.
An 87-year-old man, who presented with acute stroke and an initial NIHSS score of 18.
(A) Left anteroposterior internal carotid artery angiogram shows occlusion of the proximal superior trunk of the middle cerebral artery (arrowhead). (B) The advancement of the distal access catheter (DAC) in the middle cerebral artery was very difficult. The DAC was advanced in the proximal middle cerebral artery (arrow). (C) Post-thrombectomy anteroposterior internal carotid artery angiogram shows complete reperfusion of the middle cerebral artery; however, there is contrast extravasation (arrowhead) in the left proximal middle cerebral artery. (D) Postoperative axial CT shows subarachnoid hemorrhage.
Table 3.
Multivariable logistic regression analysis with dependent variables for successful reperfusion, complete reperfusion in all cases (n = 81).
Table 4.
Multivariable logistic regression analysis with dependent variables for successful reperfusion and complete reperfusion in the proximal DAC group (n = 38).
Table 5.
Multivariable logistic regression analysis with dependent variables for successful reperfusion and complete reperfusion in the distal DAC group (n = 45).
Fig 4.
Combined stent-retriever and distal access catheter (DAC) technique.
(A) Left anteroposterior internal carotid artery angiogram image shows occlusion of the left middle cerebral artery (arrowhead). (B) Mechanical thrombectomy was performed using stent-retriever and DAC. The DAC was advanced in the middle cerebral artery (arrow) and the stent-retriever (arrowheads) was deployed through the thrombus. (C, D) Thrombus within the stent-retriever (arrowheads) is partially captured within the DAC (E) Debris and clot fragmentation aspirated through the DAC (F) Post-thrombectomy anteroposterior internal carotid artery angiogram shows complete reperfusion of the middle cerebral artery.