WSC 2026 | Using arterial anatomy to guide thrombectomy decisions in distal medium-vessel occlusion
Elena Zapata Arriaza, MD, PhD, Seville Biomedical Research Institute, Seville, Spain, shares guidance for selecting the right device for mechanical thrombectomy in patients with distal medium-vessel occlusion. Dr Zapata Arriaza highlights the importance of taking into account the individual patient’s anatomy to improve recanalization and reduce harm. This interview took place at the 18th World Stroke Congress (WSC) in Seoul, Korea.
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Transcript
Our approach is that maybe selecting the right endovascular treatment, the right device, knowing the anatomy, we could improve the recanalization and reduce the harm of the mechanical thrombectomy. We know that the trials haven’t shown the benefit of the mechanical thrombectomy, but we think that not all the patients experience the same kind of stroke and symptoms. So there are a lot of patients that should receive endovascular treatment...
Our approach is that maybe selecting the right endovascular treatment, the right device, knowing the anatomy, we could improve the recanalization and reduce the harm of the mechanical thrombectomy. We know that the trials haven’t shown the benefit of the mechanical thrombectomy, but we think that not all the patients experience the same kind of stroke and symptoms. So there are a lot of patients that should receive endovascular treatment. And of course, we know the limitations of the trial because of the cherry picking, more or less. So our approach is to give the interventionist some tools to decide which device should be used based on the anatomical phase of the procedure. So we try to say, hey, okay, this is a very tortuous artery, so you should use this one or this other device. And this is our approach. Selecting which device and selecting which kind of difficulties you are going to face during the procedure may help the interventionist to take the right decision during the procedure. We have learned a lot in the MeVo distal occlusion, so I think that we are improving our approach, we are improving our devices and our techniques, so maybe based on this tortuosity, we should employ devices softer than we have used, maybe we don’t have to use stent retriever in the distal occlusion, and we should combine distal aspiration with stent retriever and try to improve the techniques and the devices, because there are some stent retrievers that are like sharpening objects in the distal bed of the occlusion. So maybe we should be more gentle with this distal occlusion with different approaches.
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