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

Zifu Li,Jianmin Liu,Qinghai Huang,Pengfei Yang,Pengfei Xing,Yibin Fang,Yongwei Zhang,Peng Liu,Lei Zhang

doi:10.3389/fneur.2020.00924

Abstract

Objective: Y-stent thrombectomy is a recent rescue technique for failed thrombectomy in patients with emergent large vessel occlusion. We presented case series of using Y-stent rescue technique at different sites and investigate its feasibility and safety through pooled analysis of collected case report or series.Methods: Twenty-eight cases were screened from stroke databank who underwent thrombectomy between January 2015 and June 2019. Clinical, procedural, and follow-up data were investigated and pooled analysis of published literature was analyzed.Results: The occlusion sites include carotid terminus in 14 patients; siphon segment in 3; middle cerebral artery (MCA) in 4; basilar terminus in 7. The overall recanalization rate reached 85.7% (arterial occlusive lesion score 2–3); and final reperfusion rate 85.7% (modified Thrombolysis in Cerebral Infarction 2b−3). After literature review, totally, 52 cases were included. Good clinical outcome was achieved in 26 (50%) and mortality in 7 (17.3%). There is no significant difference on the SAH complication at different sites. Literature review shows no difference between each site in the reperfusion and complication rate.Conclusion: Our case series results suggest that high recanalization rate can be effectively achieved with Y-stent rescue technique for patients with refractory emergent large vessel occlusion. The safety of using this technique at different sites needs further investigation for patients.

Highlights

Mechanical thrombectomy has been the first-line therapy for acute ischemic stroke secondary to emergent large vessel occlusion (ELVO)
The stent retrievers were separately positioned in middle cerebral artery (MCA) and anterior cerebral artery (ACA) (Figure 1), carotid siphon segment occlusion in the posterior communicating artery (PcomA) of diameter ≥1.5 mm and internal carotid artery (ICA) (Figure 2), and MCA occlusion in superior and inferior trunk and for basilar terminus occlusion positioned in bilateral posterior cerebral artery (Figure 3)
Among the 28 patients, embolic ELVO was diagnosed in 24 patients including 14 with cardiogenic strokes associated with atrial fibrillation or cardiovascular surgery, 10 with cryptogenic etiology, and atherosclerotic occlusion in 4 patients including 3 with tandem occlusion resulting from proximal atherosclerotic occlusion and 1 with atherosclerotic occlusion of the carotid terminus

Summary

Introduction

Mechanical thrombectomy has been the first-line therapy for acute ischemic stroke secondary to emergent large vessel occlusion (ELVO). Despite the availability of large-bore aspiration catheter, second-generation stent retriever and balloon guiding catheter, there is at least 10% of patients who fail to recanalize the occluded artery [3,4,5,6]. The technique has been used in refractory cases for occlusion at middle cerebral artery (MCA), basilar artery, and internal carotid artery (ICA) [8,9,10,11]. Feasibility of this technique remains unknown owing to limited cases. Analysis of our prospectively collected data, together with literature review on procedural results, complications, and outcome, was conducted in patients who underwent thrombectomy with the rescue technique

Methods

Results

Discussion

Conclusion