Balloon-Assisted Advancement Of Aspiration Catheters Across Underlying Intracranial Stenosis During Mechanical Thrombectomy: A Technical Note

Mechanical thrombectomy is the standard treatment for large-vessel occlusion stroke; however, underlying intracranial atherosclerotic stenosis (ICAS) may hinder device passage or lead to thrombus entrapment and re-occlusion after thrombectomy, necessitating adjunctive approaches. We describe a balloon-assisted technique designed to facilitate the advancement of aspiration catheters across severe intracranial stenosis during thrombectomy. Two illustrative cases are presented. In both cases, conventional approaches failed due to inability to cross the stenotic segment. A low-profile balloon was used for partial angioplasty, and the aspiration catheter was advanced during controlled balloon deflation, enabling access to post-stenotic thrombus and successful recanalization. This technical note suggests that balloon-assisted advancement may represent a feasible adjunctive strategy in selected ICAS-related large-vessel occlusions. Further studies are required to evaluate its safety and effectiveness.