Right Middle Cerebral Artery M1 Segment Acute Occlusion with Tortuous Anatomy: Use of Balloon Guide Catheter and Novel Aspiration-First Mechanical Thrombectomy Device

Endovascular mechanical thrombectomy has transformed the landscape of large vessel occlusion (LVO) strokes in the modern era. The major challenges of mechanical thrombectomy remain: (1) the ability to navigate through tortuous anatomy into the appropriate vessel, and (2) the efficacy in capturing clots of different consistencies. Here, we present a case of an acute right middle cerebral artery (MCA) M1 occlusion associated with severe proximal vessel tortuosity in a woman presenting with new onset of right-sided weakness and speech difficulty. Using an 8-French (F) balloon guide catheter system and a novel endovascular aspiration and distal access catheter, thrombolysis in cerebral infarction (TICI) reperfusion grade 3 was achieved after a single pass. The patient exhibited substantial recovery with minimal deficits at her 3-month follow- up evaluation. Ongoing debates persist regarding the optimal choice between aspiration-first and stent-retriever approaches. This case underscores the effectiveness of mechanical thrombectomy using an approach tailored to the patient’s anatomy and highlights another instance of the potential for innovative endovascular devices in the treatment of LVO.