Double Stent-Retriever Technique in Endovascular Treatment of Middle Cerebral Artery Saddle Embolus

Asadi, Hamed; Brennan, Paul; Martin, Anthony; Looby, Seamus; O’Hare, Alan; Thornton, John

doi:10.1016/j.jstrokecerebrovasdis.2015.10.005

Cited by 26 publications

(29 citation statements)

References 10 publications

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“…Subsequently, both stents are gradually retrieved out of the guiding catheter, while continuous suction is maintained through the side port of the guide catheter. 9,10 The decision to use this technique relies on several factors such as clot burden, local anatomy, duration and number of passages by a single stent retriever. 10 Two examples of mechanical thrombectomy using dual stent retrievers are depicted in Figures 1 and 2.…”

Section: Key Pointsmentioning

confidence: 99%

“…5,11 In addition to the previously mentioned criteria, the dual stent retrievers can be used specifically as a rescue technique for refractory thromboembolus at the carotid terminus, basilar tip and middle cerebral artery bifurcations, extending to both divisions, after single-stent retrieval failed. 9,10 The exclusion criteria are large infarct core on baseline CT (ASPECTS of six or less, intracranial hemorrhage, severity of comorbid factors that may render the procedure unlikely to benefit, pregnancy and contraindication to iodinated contrast. 3,[5][6][7] What are the harms?…”

Section: Who Is Eligible?mentioning

confidence: 99%

“…The limited literature on this technique suggests that it is well tolerated with a comparable risk profile. 9,10,12 Klisch and colleagues described one case of vessel perforation and seven cases of mild vasospasm with mechanical thrombectomy using dual stent retrievers as a rescue technique in 10 patients. There were no reported cases of severe vasospasm or arterial dissection.…”

Section: Who Is Eligible?mentioning

confidence: 99%

“…9,10,12 However, the results are promising, with comparable recanalization time and adverse events. According to Klisch and colleagues, this technique had an increased median total recanalization time of 60 minutes (interquartile range 45 to 87 minutes) compared with standard mechanical thrombectomy using single-stent retrieval (range 20 to 48 minutes).…”

mentioning

confidence: 96%

“…10 Two other single-case reports also showed complete recanalization without peri-or postprocedural complications for retrieval of refractory clots in the anterior circulation after standard mechanical thrombectomy using singlestent retrieval failed. 9,12 What can be expected in the future?…”

mentioning

confidence: 99%

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Dual-stent retrieval for mechanical thrombectomy of refractory clot in acute stroke as a rescue technique

Patro

Iancu

2017

CMAJ

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Section: Key Pointsmentioning

confidence: 99%

Section: Who Is Eligible?mentioning

confidence: 99%

Section: Who Is Eligible?mentioning

confidence: 99%

mentioning

confidence: 96%

mentioning

confidence: 99%

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Dual-stent retrieval for mechanical thrombectomy of refractory clot in acute stroke as a rescue technique

Patro

Iancu

2017

CMAJ

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First-line Double Stentriever Thrombectomy for M1/TICA Occlusions

et al. 2022

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Background Mechanical thrombectomy is the standard of care for acute ischemic stroke due to large-vessel occlusion; however, mechanical thrombectomy fails to achieve adequate recanalization in nearly one third of these cases. Rescue therapy using two stentrievers simultaneously yields good results in clots refractory to single stentriever treatment. We aimed to determine the safety and efficacy of first-line double stentriever thrombectomy for acute occlusion of the M1 segment of the middle cerebral artery and/or terminal internal carotid artery (TICA). Methods This single-center study prospectively enrolled consecutive patients with a single M1/TICA occlusion to undergo double stentriever thrombectomy between May and October 2020. Outcomes included successful recanalization (modified thrombolysis in cerebral infarction, TICI 2b/3), first-pass effect, procedure times, number of device passes, symptomatic intracerebral hemorrhage, National Institutes of Health Stroke Scale Score (NIHSS) at discharge, 90-day functional independence (modified Rankin scale 0–2), and 90-day mortality. Results We analyzed 39 patients median age 79 years (range 42–96 years); 23 (58.9%) female; 19 (48.7%) with TICA occlusions; 5 (12.8%) with mRS 3–5 at admission; mean NIHSS at admission, 17 ± 4.39). Mean time from symptom onset to final angiogram was 238.0 ± 94.6 min; mean intervention duration was 36.0 ± 24.2 min. The mean number of device passes was 1.5 ± 1.07. All patients had final TICI 2b/3, and 27 (69%) had TICI 2c/3 after the first pass. We observed 3 (7.9%) cases of intracerebral symptomatic hemorrhages. At 90 days, 16 (41%) patients were functionally independent and 9 (23%) had died. The percentage of patients with good clinical outcome at 90 days was 55.5% in the first-pass subgroup. Conclusion Our findings suggest that first-line double stentriever thrombectomy is safe and effective for M1/TICA occlusions.

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First Experience with the Nimbus Stentretriever

et al. 2022

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Purpose To share our first experience with the Nimbus stentretriever, a multizone device designed to assist neurointerventionalists in handling fibrin-rich clots in endovascular stroke treatment. Methods We retrospectively analyzed the data of patients who were treated with the Nimbus stentretriever at our high-volume stroke center between May 2021 and May 2022. We evaluated the number of passes before Nimbus was used, the number of passes with nimbus, as well as the recanalization success before and after Nimbus according to the modified treatment in cerebral ischemia (mTICI) scale. Also, patient characteristics, procedural times and clinical outcomes were documented. Results A total of 21 consecutive patients were included in the study. An mTICI 2b/3 could be achieved in 76.2% and mTICI 2c/3 could be achieved in 57.1%. The mean number of passes was 3.4 before the use of Nimbus, 2.2 with Nimbus, and 5.4 for all passes with and without Nimbus and 4 occlusions (19.0%) were successfully recanalized with direct aspiration after the use of Nimbus. We observed seven subarachnoid hemorrhages (33.3%) and two cases of vasospasm. Conclusion In our series, the use of Nimbus resulted in successful recanalization in half of the patients after otherwise unsuccessful thrombectomy maneuvers; therefore, it should be considered as a rescue option if the maneuver with conventional stent retrievers was unsuccessful.

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Double Stent-Retriever Technique in Endovascular Treatment of Middle Cerebral Artery Saddle Embolus

Cited by 26 publications

References 10 publications

Dual-stent retrieval for mechanical thrombectomy of refractory clot in acute stroke as a rescue technique

Dual-stent retrieval for mechanical thrombectomy of refractory clot in acute stroke as a rescue technique

First-line Double Stentriever Thrombectomy for M1/TICA Occlusions

First Experience with the Nimbus Stentretriever

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