J Cerebrovasc Endovasc Neurosurg.  2017 Sep;19(3):207-212. 10.7461/jcen.2017.19.3.207.

How to Escape Stentriever Wedging in an Open-cell Carotid Stent during Mechanical Thrombectomy for Tandem Cervical Internal Carotid Artery and Middle Cerebral Artery Occlusion

• Rho HW
• Yoon WK
• Kim JH
• Kim JH
• Kwon TH

• KMID: 2393504
• DOI: http://doi.org/10.7461/jcen.2017.19.3.207

Abstract

We present 2 cases of complicated mechanical thrombectomy involving tandem cervical internal carotid artery and middle cerebral artery occlusion using the Solitaire FR stent and simultaneous carotid stent angioplasty. During the procedures, the Solitaire stents containing the thrombus were wedged into the open-cell carotid stents, which were already deployed for proximal flow restoration. We describe the methods used to avoid and overcome such complications.

Keyword

Carotid stent; Solitaire stent; Thrombectomy; Middle cerebral artery; Tandem; Angiography

MeSH Terms

Angiography
Angioplasty
Carotid Artery, Internal*
Infarction, Middle Cerebral Artery*
Middle Cerebral Artery*
Stents*
Thrombectomy*
Thrombosis
United Nations*

Figure

• 

  Fig. 1 (A) Angiogram shows total occlusion of the right cervical ICA. (B) After partial balloon recanalization of the cervical ICA, the angiogram reveals MCA occlusion. (C) To improve proximal blood flow, the steno-occlusive carotid lesion is treated with an open-cell stent. (D) The Solitaire stent harboring the captured thrombus is caught in the open-cell carotid stent. Manipulation of a stiff guide wire around the Solitaire stent is ineffective. (E) A gross picture of the Solitaire stent capturing the thrombus. The captured thrombus renders the stent wide open, which results in subsequent complications. ICA = internal carotid artery; MCA = middle cerebral artery.

• 

  Fig. 2 (A) Initial angiogram shows total occlusion of the cervical ICA. (B) Using balloon angioplasty, this lesion is recanalized but still stenotic. MCA was still occluded after proximal recanalization. The MCA lesion was recanalized with mechanical thrombectomy using a Solitaire stent. However, after stent angioplasty for the cervical stenotic lesion using an open-cell stent, a thrombotic occlusion in the superior trunk of the MCA developed. Therefore, another mechanical thrombectomy using the Solitaire stent was performed. (C) This image shows that the Solitaire stent harboring the thrombus is caught in the distal end of the carotid stent during retrieval. (D) Complete recanalization can be observed after the complicated procedure. ICA = internal carotid artery; MCA = middle cerebral artery.

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