A Case of Acute Embolic Occlusion of the Common Carotid Artery in Which a Giant Thrombus Was Retrieved Using the Parallel Stent Retriever Technique

Abstract

We report a case of embolic occlusion of the common carotid artery (CCA) in which a giant thrombus was retrieved using the parallel stent retriever technique.Case presentation: An 84-year-old woman without anticoagulant therapy despite a history of cardioembolic stroke presented to our hospital because of left hemiparesis after developing sudden vision loss in her right eye. Emergency angiography revealed a giant thrombus in the right CCA. After arresting flow in the CCA using a balloon-guided catheter (BGC), we deployed two stent retrievers in parallel from the internal carotid artery to the CCA, and slowly retrieved them simultaneously under manual aspiration through the BGC. As a result, complete recanalization was achieved. Conclusion:Thrombi causing acute embolic occlusion of the CCA are often too large to be completely retrieved using conventional thrombectomy techniques. The parallel stent retriever technique may be effective in such cases.Keywords▶ giant thrombus, embolic occlusion of the common carotid artery, endovascular thrombectomy, cardiogenic embolism

Long-sheath Introducer-assisted Revascularization (L-SHARE) Technique for Treating Large-vessel Occlusion by a Giant Clot

“…In endovascular procedures for patients such as the present case, blocking of the BGC by a giant clot during the procedure is often seen ( 2 - 7 ). We must remove the BGC and re-navigate the catheter to the target vessels to continue MT.…”

“…Our method, named the L-SHARE technique, might be effective for managing giant clots and have several advantages over previous reports (2)(3)(4)(5)(6)(7)(8)(9). First, the L-SHARE technique might facilitate repeated aspiration from the BGC through a long-sheath introducer, even if the BGC is obstructed by a clot and removed from the body.…”

“…We occasionally perform MT for CCA or ICA orifice occlusion due to giant cardiogenic thrombi. Several previous reports demonstrated successful revascularization for LVO due to a giant clot using direct aspiration from BGC, several passes by SR under distal protection, the parallel SR deployment technique, and direct carotid exposure (2)(3)(4)(5)(6)(7)(8)(9). Although direct exposure for CCA occlusion was reported to be effec-tive, it might be more invasive and requires much more time than endovascular treatment alone.…”

Mechanical Thrombectomy Using a Large Dual-Layer Stent Retriever for Near-Occlusion of the Common Carotid Bifurcation Caused by a Giant Free-Floating Thrombus

“…Several studies have reported mechanical thrombectomy using aspiration through a balloon-guided catheter (BGC) 13 , 14) or an AC, 15) with a stent retriever under distal protection 11) or two parallel stent retrievers. 16) As mentioned above, aspiration with a BGC or an AC was ineffective in this case; therefore, a combined technique with a stent retriever was chosen. EmboTrap III 6.5 × 45 mm is a stent retriever with the largest diameter usable in Japan.…”

Technique for Recanalization of Sheath Introducer Occlusion due to Captured Thrombus during Mechanical Thrombectomy for Acute Ischemic Stroke: A Technical Note

“…In addition, even a sheath introducer (SI) may be occluded by a thrombus during MT. 2) This troublesome situation, as shown in Fig. 1 , occurs principally following withdrawal of the thrombus-occluded guiding catheter.…”