Recanalizing distal and small medium vessel occlusions – single-center experience with the new Q catheters

BACKGROUND: Mechanical recanalization of distal and small medium vessel occlusions (DVOs and MeVOs) is technically challenging and likely associated with higher complication rates. Previous studies have shown promising results using Q aspiration catheters in MeVOs. We report our experience with Q catheters in an even more distal cohort of DVOs and small MeVOs, focusing on safety and efficacy. METHODS: We retrospectively reviewed our institutional stroke database for patients with DVOs or MeVOs treated using Q catheters. Baseline characteristics, technical outcomes including modified Thrombolysis in Cerebral Infarction (mTICI) score and modified first pass effect (mFPE), as well as clinical outcomes measured by the 90-day modified Rankin Scale (mRS) were analyzed. Outcomes were stratified by occlusion type and treatment technique. Periprocedural complications and their clinical impact were systematically assessed. RESULTS: 57 occlusions in 47 patients were included. Mean age was 75.5 ± 12.7 years. Median National Institutes of Health Stroke Scale score was 7.7 ± 4.6 at admission and 4.9 ± 5.5 at discharge, while the rate of 90-day- mRS ≤ 2 was 37%. 39 were DVOs and 18 small MeVOs. Successful recanalization (mTICI ≥2b) was achieved in 75% overall, with lower rates in DVOs (71%) than MeVOs (83%). Stent retriever-assisted aspiration resulted in higher recanalization rates than aspiration alone (82% vs. 37%). mFPE was achieved in 42%. Periprocedural complications occurred in 9% of cases with no symptomatic intracranial hemorrhage (sICH) or PH2. CONCLUSION: Q catheters appear to be safe and effective for DVOs and small MeVOs, achieving favorable recanalization rates with an acceptable complication profile. While the study is limited by its small sample size and retrospective design, these findings support the potential of Q catheters as a valuable tool in the treatment of distal and small vessel occlusions. Nevertheless, consistent to the recently published large distal trials, recanalization rates are lower, and complications occur more often in DVOs than in MeVOs, reflecting a different balance between the technical challenges and the smaller expected clinical benefit.