J Cerebrovasc Endovasc Neurosurg.  2017 Jun;19(2):96-100. 10.7461/jcen.2017.19.2.96.

Dual Mechanical Thrombectomy for Recanalization of a Resistant Acute Posterior Circulation Stroke

• Peker A
• Akgoz A
• Arsava EM
• Topçuoglu MA
• Arat A

• KMID: 2393386
• DOI: http://doi.org/10.7461/jcen.2017.19.2.96

Abstract

A 71-year-old man with acute basilar artery occlusion was referred for endovascular treatment 6 hours after the onset of stroke with a Glasgow Coma Score of 3 and National Institutes of Health Stroke Scale of 27. A cerebral arteriogram revealed occlusion of the left vertebral artery proximally and thromboembolic occlusion of the basilar tip. Direct aspiration and mechanical thrombectomy with various stent retrievers failed to reconstitute arterial flow in the basilar artery. Thrombolysis in cerebral infarction 2b recanalization was achieved only after placement of double Catch Mini stent retrievers through 2 microcatheters, on both side branches of the basilar bifurcation in a kissing fashion and retrieving them simultaneously. It was possible to perform this maneuver through a single distal access catheter without any complications. On follow-up the patient awakened and was able to follow commands on his right side. To our knowledge, dual mechanical thrombectomy with stent retrievers has not been reported in the posterior circulation previously. This technique may be useful in retrieving thrombi located at major intracranial bifurcations of the posterior circulation which do not recanalize with standard mechanical thrombectomy procedures. Although bilateral access to the basilar artery through both vertebral arteries is an advantage in posterior circulation for this technique, dual mechanical thrombectomy can also be performed through a unilateral access.

Keyword

Endovascular procedures; Intracranial embolism and thrombosis; Thrombectomy; Thrombolytic therapy; Stroke; Basilar artery

MeSH Terms

Aged
Basilar Artery
Catheters
Cerebral Infarction
Coma
Endovascular Procedures
Follow-Up Studies
Humans
Intracranial Embolism and Thrombosis
National Institutes of Health (U.S.)
Stents
Stroke*
Thrombectomy*
Thrombolytic Therapy
Vertebral Artery

Figure

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  Fig. 1 Anteroposterior view of the digital subtraction angiogram revealing total occlusion of the distal third of the basilar artery without opacification of the posterior cerebral and superior cerebellar arteries bilaterally.

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  Fig. 2 Anteroposterior view following multiple thrombectomy attempts with a single stent retriever reveal a residual clot persisting at the bifurcation of the basilar artery that was impeding blood flow.

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  Fig. 3 Native image of the angiogram in anteroposterior view showing two Catch Mini devices (placed simultaneously) extending from the posterior cerebral arteries to the midbasilar segment.

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  Fig. 4 Post-procedure angiogram after simultaneous retrieval of both stent retrievers demonstrates patency of the basilar artery, superior cerebellar arteries and left posterior cerebral artery. Occlusion of the distal right posterior cerebral artery and the left superior cerebellar arteries were due to clot fragmentation.

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