Microcatheter puff technique to improve understanding and outcome of aspiration thrombectomy: A technical video

Aspiration thrombectomy is an alternative to stent retriever thrombectomy that allows for faster thrombectomy passes with less cost.1 Despite advances in technology, rates of first-pass effect remain relatively low.1-3 Attempts are being made to improve understanding of aspiration forces and interactions which may benefit thrombectomy technique and future technologies. While information from in vivo studies is limited to pre-pass and post-pass angiograms, in vitro experiments allow for more careful measuring and understanding of these aspiration forces and interactions. These in vitro studies have generated conflicting data with unclear clinical application.4-9 To better glean information from thrombectomies in real-time and also to improve efficacy, a microcatheter 'puff' technique has been developed.10 This technique consists of gentle contrast puffs from a microcatheter within the aspiration catheter. Here in video 1, we demonstrate this technique and some of its benefits, illustrated by cases of large and medium vessel occlusion with primary aspiration thrombectomy.neurintsurg;jnis-2025-023890v1/V1F1V1Video 1 .