Wireless Tenzing Crossing of Large Vessel-Occlusions – Feasibility of a Technique After Failed Stroke Thrombectomy with Traditional Approaches

Introduction To test feasibility of Tenzingplasty as bailout technique for resistant large vessel occlusion (LVO). LVO is primarily treated with endovascular thrombectomy (EVT). Up to 10% of cases fail to achieve reperfusion, often due to resistant clot characteristics, intracranial atherosclerotic disease (ICAD), or technical challenges. This study presents a case-series evaluating a bailout crossing technique-wireless "Tenzingplasty" using the Tenzing delivery catheter-for failed conventional EVT approaches with aspiration catheters and microwire crossing.Methods A retrospective review was performed between October 2025 and February 2026 at a single comprehensive stroke center, including adult patients who underwent EVT within 24 hours of stroke onset who had failed multiple aspiration and microwire crossing attempts. Wireless crossing with Tenzing catheter and subsequent Tenzingplasty was employed as a "last hope" technique to traverse and disrupt resistant occlusions in select cases (all cases included). Clinical, procedural, and outcome data were analyzed.Results All five cases achieved successful clot disruption and reperfusion, with 60% attaining complete (TICI 3) recanalization. Two patients required adjunctive stenting due to re-occlusion risk. No intraoperative complications, including vessel dissection or perforation, were observed. One patient experienced an asymptomatic subarachnoid hemorrhage. Functional outcomes were favorable: 80% achieving a 90-day modified Rankin Scale (mRS) ≤2 and no mortality reported. Mean NIHSS improved post-procedure.Conclusion This is a proof-of-concept case-series is a feasibility report that wireless Tenzingplasty may offer a rescue strategy for resistant LVO, particularly in cases involving ICAD or failed wire access. Larger, controlled studies are needed to validate its safety and broader applicability.