Abstract Details

To present a case report of double-stent retrieval thrombectomy technique.

Case report.

A 77-year-old male patient with HTN, HLD and Afib was admitted after being found unresponsive. He presented a NIHSS 23 for full left MCA syndrome, 8 hours after last time seen normal. Brain imaging showed a proximal MCA occlusion and a large perfusion defect (Tmax>6s=241, CBF<30%=0). We decided to perform thrombectomy. Diagnostic angiogram demonstrated an occlusion of the proximal left MCA. First pass with stent retriever achieved recanalization of the superior division only with subsequent occlusion. Six more unsuccessful attempts were made with single stent retriever plus aspiration technique, without reperfusion. Therefore, it was decided to use two stents concurrently. A Trevo and a Solitaire stent retrievers were deployed in each M2 division, with their proximal halves overlapping in the proximal M1. Both stents were slowly withdrawn, and suction aspiration was applied through a Penumbra 68 system. Follow up angiogram showed complete recanalized superior and inferior divisions, mTICI 2c.

Usually, the etiology of acute bifurcation occlusions is embolic, and the high mobility of these clots makes it difficult to retrieve it. Double-stent is a rescue technique where two stents are deployed in two different branches and retrieved simultaneously, which allows to prevent the clot mobility into another segment. It has been used in different countries around the world and seems to be safe. Nevertheless, complications like emboli formation and dissection can arise, although it was not observed in the reported procedure. We hope to add to the growing literature and call for attention to this novel technique.