{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T19:50:08Z","timestamp":1782849008712,"version":"3.54.5"},"reference-count":24,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2026,6,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2013M3, A2\u2013A3, and P1\u2013P2 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>24 patients were included (mean age 74\u00b114.6 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) \u22652b) was achieved in 87.5% of patients, including near-complete or complete reperfusion (mTICI 2c\u20133) 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\u20132) was observed in 6 of 12 patients (50%) with available follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jnis-2026-025293","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:59:35Z","timestamp":1782845975000},"page":"jnis-2026-025293","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Stent retriever-assisted intra-arterial lysis for distal vessel occlusions: a feasible pharmacomechanical rescue strategy"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3195-9601","authenticated-orcid":false,"given":"Judith","family":"Cendrero","sequence":"first","affiliation":[{"name":"Stroke Unit, Vall d\u2019Hebron University Hospital, Barcelona, Spain"},{"name":"Vall d\u2019Hebron Research Institute, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Requena","sequence":"additional","affiliation":[{"name":"Neurology, Hospital Universitari Vall d\u2019Hebron, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7953-3795","authenticated-orcid":false,"given":"Marc","family":"Rodrigo-Gisbert","sequence":"additional","affiliation":[{"name":"Stroke Unit, Vall d\u2019Hebron University Hospital, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3245-917X","authenticated-orcid":false,"given":"Francesco","family":"Diana","sequence":"additional","affiliation":[{"name":"Vall d\u2019Hebron Research Institute, Barcelona, Spain"},{"name":"Interventional Neuroradiology, Vall d\u2019Hebron University Hospital, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6108-7977","authenticated-orcid":false,"given":"Magda","family":"Jab\u0142o\u0144ska","sequence":"additional","affiliation":[{"name":"2nd Department of Radiology, Medical University of Gda\u0144sk, Gda\u0144sk, Poland"},{"name":"Stroke Research, Vall d\u2019Hebron Research Institute, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"de Dios Lascuevas","sequence":"additional","affiliation":[{"name":"Neuroradiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6736-1535","authenticated-orcid":false,"given":"Alejandro","family":"Tomasello","sequence":"additional","affiliation":[{"name":"Stroke Unit. Neurology, Hospital Vall d\u2019Hebron, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology, Vall d\u2019Hebron University Hospital, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9060-2109","authenticated-orcid":false,"given":"Mayank","family":"Goyal","sequence":"additional","affiliation":[{"name":"Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6133-0788","authenticated-orcid":false,"given":"Cristina","family":"M\u00e1rquez Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Stroke Research Group, Vall d\u2019Hebron Institut de Recerca, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4278-8222","authenticated-orcid":false,"given":"Jiahui","family":"Li","sequence":"additional","affiliation":[{"name":"Stroke Research, Vall d\u2019Hebron Research Institute, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9242-043X","authenticated-orcid":false,"given":"Marc","family":"Ribo","sequence":"additional","affiliation":[{"name":"Stroke Unit. 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