Solo navigation with SOFIA 6F aspiration catheter (SNAKE Technique) as a first-line mechanical thrombectomy approach: a single-center, large-cohort, real-world experience

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INTRODUCTION: Several methods of clot extraction during mechanical thrombectomy (MT) have been developed, among which the SOFIA 6F aspiration catheter (SAC) solo navigation (SNAKE) and aspiration technique has become the preferred approach at our institution. We present a single-center, retrospective, large-cohort, real-world study focusing on the SAC's ability to navigate vascular anatomy without additional devices and its efficacy in clot removal. MATERIAL AND METHODS: The cohort consisted of 109 consecutive patients who underwent MT with an intention to be treated with SNAKE and aspiration. We analyzed the efficacy of SAC navigation, clot extraction, costs, procedural safety and duration, as well as potential factors reducing SNAKE efficacy. RESULTS: Overall, 76.1% of SNAKE procedures were successful. In the subgroup of 83 successful SNAKE procedures, subsequent SAC aspiration achieved a first-pass effect (FPE) Thrombolysis In Cerebral Infarction (TICI) 2c-3 in 57.8% of cases and final TICI 2b-3 in 83.1% of cases. Overall, regardless of SNAKE success or MT technique used, final TICI 2b-3 was achieved in 97.2% of cases, and the FPE rate was 57.7%. Successful SNAKE resulted in a significantly shorter groin puncture-to-recanalization time (mean 18.66 min vs. 29.46 min, p = 0.0004) and significant cost reduction in subsequent MTs (mean €2,824.02 vs. €3,948.34, p = 0.0017). CONCLUSIONS: SAC SNAKE navigation with aspiration is a safe, cost-effective, relatively simple, and fast MT method, achieving high first-pass rates and good final angiographic re sults. Se vere intracranial carotid artery at herosclerosis can significantly hinder SNAKE navigation. In cases of failed SNAKE or an insufficient aspiration effect, this method can be easily combined with a stent-retriever (SR) to ensure optimal navigation and high final angiographic success.

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