J Korean Soc Radiol.  2012 Jul;67(1):1-6.

Refinement of a Thrombectomy Technique to Treat Acute Ischemic Stroke: Technical Note on Microcatheter Advance during Retrieving Self-Expandable Stent

• Youn SW
• Kim HK

Abstract

Temporary stenting and thrombectomy by use of the Solitaire stent (ev3, Irvine, CA, USA) has shown prompt and successful recanalization of the acutely occluded major cerebral artery. However, even if rarely reported, inadvertent stent detachment may occur as an innate drawback and full deployment of the stent was considered to increase the risk. In our patients, the Solitaire stent did not fully unfold to prevent inadvertent detachment. Before retrieval of the stent, the tip of the microcatheter was advanced forward carefully under fluoroscopic observation until it met the presumed thrombus segment and a subtle sense of resistance was felt in the fingers guiding the stent. After retrieval, complete recanalization was achieved, and the thrombus was trapped between the tip of the microcatheter and the stent strut. We present 2 cases of successful thrombi captures by advancing a microcatheter during Solitaire stent retrieval, and we suggest that advancing the microcatheter can be a useful refinement to the thrombectomy technique for acute ischemic stroke.

MeSH Terms

Cerebral Arteries
Fingers
Humans
Stents
Stroke
Thrombectomy
Thrombosis

Reference

1. Klisch J, Clajus C, Sychra V, Eger C, Strasilla C, Rosahl S, et al. Coil embolization of anterior circulation aneurysms supported by the Solitaire AB Neurovascular Remodeling Device. Neuroradiology. 2010. 52:349–359.

2. Henkes H, Flesser A, Brew S, Miloslavski E, Doerfler A, Felber S, et al. A novel microcatheter-delivered, highly-flexible and fully-retrievable stent, specifically designed for intracranial use. Technical note. Interv Neuroradiol. 2003. 9:391–393.

3. Roth C, Papanagiotou P, Behnke S, Walter S, Haass A, Becker C, et al. Stent-assisted mechanical recanalization for treatment of acute intracerebral artery occlusions. Stroke. 2010. 41:2559–2567.

4. Castaño C, Dorado L, Guerrero C, Millán M, Gomis M, Perez de la Ossa N, et al. Mechanical thrombectomy with the Solitaire AB device in large artery occlusions of the anterior circulation: a pilot study. Stroke. 2010. 41:1836–1840.

5. Miteff F, Faulder KC, Goh AC, Steinfort BS, Sue C, Harrington TJ. Mechanical thrombectomy with a self-expanding retrievable intracranial stent (Solitaire AB): experience in 26 patients with acute cerebral artery occlusion. AJNR Am J Neuroradiol. 2011. 32:1078–1081.

6. Penumbra Pivotal Stroke Trial Investigators. The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke. 2009. 40:2761–2768.

7. Smith WS, Sung G, Saver J, Budzik R, Duckwiler G, Liebeskind DS, et al. Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke. 2008. 39:1205–1212.

8. Levy EI, Mehta R, Gupta R, Hanel RA, Chamczuk AJ, Fiorella D, et al. Self-expanding stents for recanalization of acute cerebrovascular occlusions. AJNR Am J Neuroradiol. 2007. 28:816–822.

9. Brekenfeld C, Schroth G, Mattle HP, Do DD, Remonda L, Mordasini P, et al. Stent placement in acute cerebral artery occlusion: use of a self-expandable intracranial stent for acute stroke treatment. Stroke. 2009. 40:847–852.

10. Suh SH, Lee KY, Hong CK, Kim BM, Kim CH, Chung TS, et al. Temporary stenting and retrieval of the self-expandable, intracranial stent in acute middle cerebral artery occlusion. Neuroradiology. 2009. 51:541–544.