Left M2 Occlusion with Thrombolysis in Cerebral Infarction (TICI) 2b Recanalization Using "solumbra" Technique: Video Case

Mechanical thrombectomy has become the accepted standard of care in patients with large-vessel occlusions; however, the management of more distal occlusions is more variable. Although often less clinically severe than proximal occlusions, M2 occlusions can cause significant disability, particularly when they occur in the dominant cerebral hemisphere. Recanalization of M2 occlusions with intravenous recombinant tissue plasminogen activator has been reported to be unreliable (only successful in 30.8% of cases). Reliable recanalization of M2 occlusions (thrombolysis in cerebral infarction [TICI] grade 2b or 3 in 76.9% of cases) using contemporary endovascular techniques has been reported. A multi-institutional experience demonstrated similar radiographic and clinical success rates when comparing direct aspiration and primary stent retrieval to treat M2 occlusions. In this video, we present the case of a 62-yr-old woman with a left M2 occlusion treated using the "Solumbra" technique. This technique utilizes a stent retriever in conjunction with aspiration, which is achieved by advancing the aspiration catheter adjacent to the clot. The small caliber of the M2 segment prohibits the advancement of the large-bore aspiration catheter into this segment. However, as demonstrated in this video, placement of the aspiration catheter at the M2 ostia with deployment of the stent retriever in the M2 clot can provide effective recanalization. It should be noted that care should be taken when advancing a guide catheter into the petrous carotid artery for support as this is an advanced maneuver and may increase the risk of iatrogenic injury in inexperienced hands. Consent was obtained from the patient prior to performing the procedure. Institutional Review Board approval is not required for the report of a single case.