{
  "abstract": "Introduction The optimal endovascular treatment strategy for medium and distal vessel occlusions remains undefined given the anatomical challenges of distal vessels. Stent retriever-assisted intra-arterial lysis (SAIL) is a pharmacomechanical technique designed to facilitate clot dissolution while minimizing mechanical stress on fragile distal vessels.Methods We performed a retrospective single-center analysis of consecutive patients with acute ischemic stroke due to distal vessel occlusions treated with SAIL between November 2022 and January 2026. Distal occlusions included M2–M3, A2–A3, and P1–P2 segments, and were classified as primary or secondary. SAIL consisted of temporary stent retriever deployment across the thrombus to restore flow, followed by intra-arterial tirofiban infusion through a distal access catheter and subsequent device resheathing. Primary outcomes were feasibility and safety; secondary outcomes included angiographic reperfusion and clinical outcomes.Results 24 patients were included (mean age 74±14.6 years; median baseline National Institutes of Health Stroke Scale (NIHSS) 16). Most occlusions involved the middle cerebral artery territory (79.2%). SAIL was predominantly used after unsuccessful mechanical thrombectomy (70.8%), with a median of two prior device passes. Successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b) was achieved in 87.5% of patients, including near-complete or complete reperfusion (mTICI 2c–3) in 62.5%. Any intracranial hemorrhage occurred in 25.0% of patients and symptomatic intracranial hemorrhage in 4.2%. At 90 days, functional independence (modified Rankin Scale 0–2) was observed in 6 of 12 patients (50%) with available follow-up.Conclusions SAIL was feasible and achieved high reperfusion rates with a low rate of symptomatic intracranial hemorrhage despite frequent use as rescue therapy after failed thrombectomy. These findings support further evaluation of pharmacomechanical strategies for distal vessel occlusions.",
  "authors": [
    {
      "affiliations": [
        "Stroke Unit, Vall d’Hebron University Hospital, Barcelona, Spain",
        "Vall d’Hebron Research Institute, Barcelona, Spain"
      ],
      "name": "Judith Cendrero"
    },
    {
      "affiliations": [
        "Neurology, Hospital Universitari Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Manuel Requena"
    },
    {
      "affiliations": [
        "Stroke Unit, Vall d’Hebron University Hospital, Barcelona, Spain"
      ],
      "name": "Marc Rodrigo-Gisbert"
    },
    {
      "affiliations": [
        "Vall d’Hebron Research Institute, Barcelona, Spain",
        "Interventional Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain"
      ],
      "name": "Francesco Diana"
    },
    {
      "affiliations": [
        "2nd Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland",
        "Stroke Research, Vall d’Hebron Research Institute, Barcelona, Spain"
      ],
      "name": "Magda Jabłońska"
    },
    {
      "affiliations": [
        "Neuroradiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain"
      ],
      "name": "Marta de Dios Lascuevas"
    },
    {
      "affiliations": [
        "Stroke Unit. Neurology, Hospital Vall d’Hebron, Barcelona, Spain"
      ],
      "name": "Alejandro Tomasello"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain"
      ],
      "name": "David Hernandez"
    },
    {
      "affiliations": [
        "Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Mayank Goyal"
    },
    {
      "affiliations": [
        "Stroke Research Group, Vall d’Hebron Institut de Recerca, Barcelona, Spain"
      ],
      "name": "Cristina Márquez González"
    },
    {
      "affiliations": [
        "Stroke Research, Vall d’Hebron Research Institute, Barcelona, Spain"
      ],
      "name": "Jiahui Li"
    },
    {
      "affiliations": [
        "Stroke Unit. Neurology, Hospital Vall d’Hebron, Barcelona, Spain",
        "Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain"
      ],
      "name": "Marc Ribo"
    }
  ],
  "title": "Stent retriever-assisted intra-arterial lysis for distal vessel occlusions: a feasible pharmacomechanical rescue strategy",
  "uid": "3e860d8a-0fdf-5137-8178-a1126e2dd3d0"
}