Crossing double stent retriever technique for refractory terminal internal carotid artery occlusion
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 oc...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | Radiology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1930043322001960 |
| _version_ | 1817989434415513600 |
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| author | Isao Sasaki, MD, MBA Taichiro Imahori, MD, PhD Tatsuya Yano, MD Masanori Gomi, MD Junko Kuroda, MD, PhD Norikata Kobayashi, MD, MBA Kimitoshi Sato, MD Yoji Niwa, MD Koichi IwasaKi, MD, PhD Hiroshi Hasegawa, MD, PhD |
| author_facet | Isao Sasaki, MD, MBA Taichiro Imahori, MD, PhD Tatsuya Yano, MD Masanori Gomi, MD Junko Kuroda, MD, PhD Norikata Kobayashi, MD, MBA Kimitoshi Sato, MD Yoji Niwa, MD Koichi IwasaKi, MD, PhD Hiroshi Hasegawa, MD, PhD |
| author_sort | Isao Sasaki, MD, MBA |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-14T00:45:47Z |
| format | Article |
| id | doaj.art-1d5ead301cf64f7790dd9b0a876b2eec |
| institution | Directory Open Access Journal |
| issn | 1930-0433 |
| language | English |
| last_indexed | 2024-04-14T00:45:47Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Radiology Case Reports |
| spelling | doaj.art-1d5ead301cf64f7790dd9b0a876b2eec2022-12-22T02:22:00ZengElsevierRadiology Case Reports1930-04332022-06-0117618481852Crossing double stent retriever technique for refractory terminal internal carotid artery occlusionIsao Sasaki, MD, MBA0Taichiro Imahori, MD, PhD1Tatsuya Yano, MD2Masanori Gomi, MD3Junko Kuroda, MD, PhD4Norikata Kobayashi, MD, MBA5Kimitoshi Sato, MD6Yoji Niwa, MD7Koichi IwasaKi, MD, PhD8Hiroshi Hasegawa, MD, PhD9Department of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, JapanDepartment of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, Japan; Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo 650-0017, Japan; Correspondence author.Department of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, JapanDepartment of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, JapanDepartment of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, JapanDepartment of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, JapanDepartment of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, JapanDepartment of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, JapanDepartment of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, JapanDepartment of Neurosurgery, Ainomiyako Neurosurgery Hospital, Osaka, JapanMechanical 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.http://www.sciencedirect.com/science/article/pii/S1930043322001960Acute ischemic strokeLarge vessel occlusionEndovascular treatmentMechanical thrombectomyStent retrieverDevice-clot-vessel interaction |
| spellingShingle | Isao Sasaki, MD, MBA Taichiro Imahori, MD, PhD Tatsuya Yano, MD Masanori Gomi, MD Junko Kuroda, MD, PhD Norikata Kobayashi, MD, MBA Kimitoshi Sato, MD Yoji Niwa, MD Koichi IwasaKi, MD, PhD Hiroshi Hasegawa, MD, PhD Crossing double stent retriever technique for refractory terminal internal carotid artery occlusion Radiology Case Reports Acute ischemic stroke Large vessel occlusion Endovascular treatment Mechanical thrombectomy Stent retriever Device-clot-vessel interaction |
| title | Crossing double stent retriever technique for refractory terminal internal carotid artery occlusion |
| title_full | Crossing double stent retriever technique for refractory terminal internal carotid artery occlusion |
| title_fullStr | Crossing double stent retriever technique for refractory terminal internal carotid artery occlusion |
| title_full_unstemmed | Crossing double stent retriever technique for refractory terminal internal carotid artery occlusion |
| title_short | Crossing double stent retriever technique for refractory terminal internal carotid artery occlusion |
| title_sort | crossing double stent retriever technique for refractory terminal internal carotid artery occlusion |
| topic | Acute ischemic stroke Large vessel occlusion Endovascular treatment Mechanical thrombectomy Stent retriever Device-clot-vessel interaction |
| url | http://www.sciencedirect.com/science/article/pii/S1930043322001960 |
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