Endovascular Thrombectomy for Distal Occlusion Using a Semi-Deployed Stentriever: Report of 2 Cases and Technical Note

Abstract

Distal intracranial occlusions can sometimes cause significant neurological deficits. Endovascular thrombectomy in these vessels may improve outcome but carry a higher risk of haemorrhagic complications due to the small calibre and tortuosity of the target vessel. We report two cases of isolated M2/3 artery occlusion causing dense hemiplegia that was successfully treated with stent retrieval thrombectomy. A "semi-deployment technique" of a 3 mm stentriever was employed at the M2/3 bifurcation of the middle cerebral artery. Partial stent unsheathing allowed adequate clot engagement while avoiding excessive tension by the stent metal struts along the tortuous course of a distal vessel. Complete revascularization was achieved after firstpass of the stent retriever without complication, resulting in good clinical outcome in both cases. The described semi-deployment technique reduces the radial and tractional force exerted by the stentreiver on small branches, and may reduce the risk of vessel laceration or dissection in distal vessel thrombectomy.

Endovascular treatment for M3 occlusions

“…In other studies, this rate has been around 80%. 4,6,11 We think that the high rate of recanalisation in our study is due to the fact that the procedure was performed by same experienced endovascular interventionists. For example, entrapment of the thrombus and M3 thrombectomy were performed in the same session for a patient with mobile thrombus (embolic) material in the distal right CCA (Figure 4).…”

“…1 Yue Wan et al reported two cases of M2/3 artery occlusions, which were successfully managed with endovascular treatment. 11 Most endovascular trials have included patients with proximal occlusions. Due to the current lack of data on the effectiveness of endovascular treatment, its safety has not been clearly demonstrated for M3 occlusions.…”

Anatomical distribution and clinical significance of middle cerebral artery M2 segment vessel occlusions and its cortical branches in acute ischaemic stroke patients

“…The wide variation of the branching pattern has a strong impact on the vascular territory at risk and leads to various clinical presentations 15. Even small vessel occlusions can lead to severe neurological deficits depending on the eloquence of the affected vascular territory 16. Thus, we looked at the different MeVO of the MCA.…”

Evaluation of the Partial Re-Sheathing Technique with the Solitaire Stent Retrieval System <i>In Vitro</i> Model and a Representative Case

“…4) In addition to the full deployment technique, partial deployment or re-sheathing techniques have also been reported. 6,7) The partial deployment was used to remove the thrombus at the M2/3 bifurcation of the middle cerebral artery (MCA). They deployed half the working length of the stent retriever with adequate length to engage the thrombus and avoided unnecessary length of stent deployment across the sharp angles of the vessel.…”

“…They deployed half the working length of the stent retriever with adequate length to engage the thrombus and avoided unnecessary length of stent deployment across the sharp angles of the vessel. 6) The re-sheathing technique with the Solitaire device, which was achieved by pushing the aspiration catheter, secured the thrombus within the stent and decreased the distance over which the thrombus needed to travel. 7) An in vitro study has described the characteristics of various stent retrievers; 8) however, to the best of our knowledge, no study has examined the partial deployment or re-sheathing status with the Solitaire device in vitro model.…”