Crossing double stent retriever technique for refractory terminal internal carotid artery occlusion

Radiology Case Reports

article

Isao Sasaki¹  Taichiro Imahori¹  Tatsuya Yano¹  Masanori Gomi¹  Junko Kuroda¹  Norikata Kobayashi¹  Kimitoshi Sato¹  Yoji Niwa¹  Koichi IwasaKi¹  Hiroshi Hasegawa¹ 

[1] Department of Neurosurgery, Ainomiyako Neurosurgery Hospital

关键词: Acute ischemic stroke;    Large vessel occlusion;    Endovascular treatment;    Mechanical thrombectomy;    Stent retriever;    Device-clot-vessel interaction;   

DOI  :  10.1016/j.radcr.2022.03.023

学科分类：生物化学工程

来源: University of Washington * Department of Radiology

【 摘 要 】

Mechanical thrombectomy is highly effective for the recovery of acute ischemic stroke with large vessel occlusion. However, refractory occlusions are still encountered despite the use of currently available devices. In this article, we present a case of refractory terminal internal carotid artery occlusion treated with the “crossing double stent retriever technique.” Two thrombectomy procedures with the combined technique using a stent retriever and aspiration catheter failed to recanalize the terminal internal carotid artery occlusion that involved the dominant anterior cerebral artery . We then applied the crossing double stent retriever technique as a rescue technique. Two microcatheters were advanced across the occlusion: one to the anterior cerebral artery and the other to the middle cerebral artery . First, a Trevo NXT 4 mm stent retriever was deployed from the anterior cerebral artery. Next, an additional Trevo NXT 4 mm stent retriever was deployed from the middle cerebral artery, and full immediate restoration of flow was achieved on angiography . Intraprocedural radiological images showed that the 2 microcatheters traversed different pathways, and the 2 stent retrievers completely covered the entire vessel with apparent in-stent clot sign. Both stent retrievers were then pulled back together, and a hard clot was retrieved. Subsequent angiography revealed complete recanalization . The crossing double stent retriever technique seems an effective rescue technique for treating refractory terminal internal carotid artery occlusion, especially with the anatomical feature of branching of the dominant anterior cerebral artery. This technique can facilitate the device-clot-vessel interaction by engaging the clot via 2 different device pathways.

【 授权许可】

CC BY|CC BY-NC-ND