Abstract Number ‐ 178: Optimizing Skin to Device at Occlusion Time Utilizing A Non‐exchange Technique with Novel Steerable Microcatheter
Authors: Al‐Kawaz Mais , Shigematsu Tomoyoshi , Berenstein Alejandro , Fifi Johanna T 
Published: April 2023

Introduction
Vascular tortuosity and difficult access to the target vessel during mechanical thrombectomy is one of the reasons for failed reperfusion. The 021 Bendit adjustable micro catheter is a torqueable microcatheter with an adjustable, 360 rotating, bendable tip. Its unique structure provides it with trackability and support allowing it to be used as a select catheter for the guide and to directly access the target vessel without a guidewire. This feature can result in significant reduction in groin puncture to recanalization time, with possible implications on patient outcomes. It is also designed to fit in a standard sized aspiration catheter and allow delivery of a stentriever device if needed. Herein we describe the first US experience in 021 Bendit adjustable microcatheter in vessel selection and intracranial navigation in patients with large vessel occlusions.

Methods
We describe our experience with three patients who presented with large vessel occlusions for mechanical thrombectomy in July 2022. The system with guide catheter loaded with aspiration catheter and Bendit adjustable microcatheter was used to directly select the target vessels starting at the arteriotomy site, off the aortic arch and its support was used to advance the guide catheter into the cervical segment. It was then delivered to the intracranial circulation where it was used to deliver the aspiration catheter.

Results
Patient A is a 73‐year‐old man with a left M1 occlusion. The Bendit microcatheter was advanced through a 071 intermediate catheter and through a 088 guide catheter and was used to select the left common carotid artery. Time between device entering the body to clot touch time of 18 minutes. Patient B is a 57‐year‐old man who presented with a left cavernous internal carotid artery occlusion. The Bendit microcatheter was advanced through a 071 intermediate catheter and a 088 guide catheter was used to successfully select the left common carotid artery.Time between device entering body and bendit being at first lesion is 3 minutes. Patient C is a 60‐year‐old woman with a basilar occlusion. A 088 guide catheter was advanced over 071 intermediate catheter which was advanced over the Bendit microcatheter into the aortic arch. The Bendit microcatheter was maneuvered to select the right subclavian artery and the right vertebral artery, the system was subsequently advanced over the Bendit microcatheter intracranially. Time between groin puncture to aspiration device at the clot was 5 minutes.

Conclusions
The Bendit steerable microcatheter can be used to maneuver through the aortic arch and successfully select the target vessel without an exchange and without a guidewire. This approach can dramatically reduce access to recanalization time and ultimately neurologic outcomes in patients undergoing mechanical thrombectomy. As more experience is obtained, best practices will be able to achieve consistently lower times.