Balloon-assisted retrieval of detached microwire tip during mechanical thrombectomy

Mechanical thrombectomy is the standard of care for acute ischemic stroke due to large vessel occlusion.1 The reported intraprocedural complication rate is approximately 8%, including emboli to new territory, perforations and dissections.2 3 Rarely, technical device failures such as microwire tip detachment can occur during neurointerventional procedures. Previously reported cases of guidewire detachment have utilized microsnares or stent retrievers for retrieval.4 5 In this technical video 1, we describe one such complication of microwire tip detachment and its successful retrieval. In our case, the proximal end of the detached microwire was initially pinned within the aspiration catheter using a compliant balloon and retrieved up to the cervical segment of the internal carotid artery (ICA), where the detached tip slipped out of the aspiration catheter. From the cervical ICA, the detached tip was successfully retrieved using a stent retriever. This balloon-anchored retrieval (BAR) technique may also be useful in managing a detached microcatheter tip. Video 1- media110.1136/jnis-2025-024154.video016379570268112jnis2025024154media1