Utility of a Y-configured stentriever technique as a rescue method of thrombectomy for an intractable rooted thrombus located on the middle cerebral artery bifurcation: technical note

Abstract

<jats:p>Mechanical thrombectomy with stentriever and/or aspiration is the new gold standard for the treatment of acute strokes with large-vessel occlusion. As many as 20% of cases remain refractory to current stentriever and/or aspiration devices. “Saddle clots” obstructing a bifurcation may be a particular challenge for recanalization with conventional techniques and devices. The authors describe an alternative technique to bifurcation occlusions resistant to the conventional mechanical thrombectomy approach in which they simultaneously deployed 2 stentrievers into both branches of an occluded bifurcation. This stentriever Y-configuration was very effective in managing a challenging intracranial bifurcation occlusion.</jats:p>

Parallel Stent Retriever Technique for a Refractory Middle Cerebral Artery Embolism: A Technical Case Report

“…15) Several case reports also confirmed the efficacy of the Y-stent technique. [1][2][3][4][5][6][7][8][9][10][11][12][13] In the present case, the thrombus was present in the M1 segment, and the retrieval force was improved by simultaneously deploying two different SRs in parallel in the M1 segment, leading to recanalization. When two microcatheters take different thrombus routes, grasping the thrombus may be possible with two SRs.…”

“…Several thrombectomy techniques using multiple SRs have been performed in patients with difficult recanalization. [10][11][12][13][14][15] Klisch et al 10) reported 10 patients who underwent with difficulty achieving recanalization using the conventional techniques alone.…”

Y-Stent Rescue Technique for Failed Thrombectomy in Patients With Large Vessel Occlusion: A Case Series and Pooled Analysis

“…After literature review, 24 cases with different site occlusions were included for pooled analysis from five published articles (8,9,(11)(12)(13)(14), including 19 cases with MCA, 1 with basilar terminus, and 4 with carotid terminus. Clinical outcome was unavailable in three patients with MCA occlusion and one patient with basilar terminus (9,12,13). The detailed procedural results plus ours are presented in Table 3.…”

“…Asadi et al (9) also reported the application of Trevo ProVue and EmboTrap for the Y-stent thrombectomy technique in a patient with MCA bifurcation occlusion. The visible stent retriever has the advantage of displaying the position of the stent and interaction between the two stent retrievers (12). Several published reports have described the Y-stent rescue technique for MCA and carotid terminus occlusion (8,9).…”

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

“…A method to promote several passes under distal filter protection is not covered by health insurance in Japan. Regarding the efficacy of a procedure to retrieve a thrombus by deploying two stent retrievers, a method to deploy two stents in the superior and inferior trunks to M1 segment for a thrombus at the MCA bifurcation and simultaneously collect them, [10][11][12][13] and a method to shift two stents back and forth or deploy them in parallel for retrieval of a long, large thrombus involving the ICA to MCA 14) was previously reported. However, to the best of our knowledge, no study has reported retrieval of a giant thrombus involving the CCA to ICA origin, as observed in our patient.…”