Thrombectomy of a distal occlusion of the middle cerebral artery (M3-segment) using the controlled mini-pinning technique.

Mechanical thrombectomy for distal, medium vessel occlusions is gaining importance and increasingly performed. However, there is an ongoing debate on selection criteria for thrombectomy and the best techniques for fast and effective complete reperfusion. Here, we present a case where we use a combination of a stent retriever and aspration catheter for a distal middle cerebral artery occlusion (M3-segment). The aspiration catheter was advanced over the wire of the stent-retriever after deployment - but not using a blind exchange with the mini-pinning technique as previously described. Instead, a new extension wire to the stent retriever was used to advance the aspiration catheter safely. This technique can be important in the near future as distal occlusions will be treated more regularly and trials randomizing patients with distal occlusions such as the Distal trial are underway.