The preliminary analysis of double stent-retriever thrombectomy for acute internal carotid artery occlusion

Abstract

Objective To explore the safety and efficacy of Solitaire AB double stents in acute occlusions in bifurcation of cerebral artery (including the ends of internal carotid artery and middle cerebral artery M1 segment). Methods The clinical and imaging data of six cases treated with the double stent retriever technique using the Solitaire AB system in Wuhan No. 1 Hospital from January to November 2017 were retrospectively analyzed. And the therapeutic effect and postoperative complications of them were analyzed. Results One patient took the double stents directly, whereas five patients were treated with double stent-retriever thrombectomy after the failure of single stent thrombectomy. All of the six patients achieved recanalization successfully (modified thrombolysis in cerebral infarction (mTICI) 3 in five patients, mTICI 2b in one). All patients had no intracranial hemorrhage immediately after thrombectomy. In the 24 hours, 7 days and 2 weeks, the median NIHSS score was 10 (3-17), 3(1-15) and 1 (0-15), respectively. During perioperative period, one patient had asymptomatic cerebral hemorrhage, one died of symptomatic cerebral hemorrhage within 48 hours, and one was complicated with pulmonary infection. Five patients were followed up by outpatient visit, and four patients showed good outcome (modified Rankin Scale score ≤2). Conclusion In the emergency revascularization of acute cerebral artery occlusion at arterial bifurcation, double stent-retriever is better at increasing the efficacy of thrombectomy and is safe compared with single stent mechanical thrombectomy. Key words: Stroke; Carotid artery, internal; Middle cerebral artery; Stents; Mechanical thrombectomy