Macrowire for intracranial thrombectomy in medium vessel occlusion stroke (MINT-MeVO) : an early multicenter experience

Introduction Mechanical thrombectomy (MT) is standard of care for large vessel occlusion stroke, but its role in medium vessel occlusion (MeVO) remains uncertain. Recent trials have not shown clear benefit, partly due to patient selection and technique variability. Several MT approaches have been described, including the direct aspiration first-pass technique and stent retriever thrombectomy. A novel macrowire has been introduced to deliver an aspiration catheter directly to the clot without a traditional microwire-microcatheter system. We evaluated the feasibility and safety of this approach in MeVO stroke. Methods Macrowire for Intracranial Thrombectomy-MeVO is a multicenter, retrospective, observational study of consecutive patients with MeVO treated with MT using a macrowire to deliver the aspiration catheter. Data were collected over 12 months and included demographics, vascular risk factors, baseline modified Rankin Scale, National Institutes of Health Stroke Scale (NIHSS), occlusion site, procedural metrics, angiographic outcomes, and complications. Results Fifty-nine patients were included (median age 65 years; 36% women). Median NIHSS was 11 (IQR 8–19) and median Alberta Stroke Program Early CT Score was 9 (range 7–10). Successful advancement of the aspiration catheter over the macrowire was achieved in 57/59 cases (96.6%). Median access-to-first pass time was 16 min (IQR 11–19) and median access-to-reperfusion time was 20 min (IQR 15.0–33.8). Successful reperfusion (thrombolysis in cerebral infarction (TICI) ≥2B) occurred in 91.5% of patients (TICI 3: 23; 2C: 22; 2B: 9). Two cases required microcatheter bailout, and no wire-related perforations were observed. Conclusions Macrowire-assisted aspiration thrombectomy appears safe and feasible for MeVO, enabling efficient catheter delivery and high rates of successful reperfusion. Trial registration number NCT06148675 .