Microsurgical Removal of Snagged Stent Retriever During Endovascular Embolectomy for Acute Ischemic Stroke

Yokoya, Shigeomi; Hino, Akihiko; Takezawa, Hidesato; Katsumori, Tetsuya; Goto, Yukihiro; Hashimoto, Youichi; Oka, Hideki

doi:10.1016/j.wneu.2017.12.067

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…Yokoya et al reported a case in which a stent retriever was removed via craniotomy. 3) Under microscopic observation, they noted that pulling on the stent retriever during craniotomy resulted in strong vascular deviation, which raised concern about damaging the perforating branch. Thus, they recommended that extreme caution should be exercised to prevent applying excessive stress on devices that cannot easily be retrieved.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…While rare, a microcatheter, 1) micro-guidewire, 2) or stent retriever 3) may be difficult to remove during endovascular treatment. As there is no established countermeasure, the following actions are commonly used: (1) temporary wait-and-see, 4) (2) removal via craniotomy, 3) or (3) leaving the device in place. 1 , 2 , 4) We experienced a case of a retriever that became wedged and difficult to re-sheath due to a vasospasm in a patient with occlusion of the inferior branch (M2) of the middle cerebral artery (MCA).…”

Section: Introductionmentioning

confidence: 99%

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A Novel Technique to Retrieve a Snagged Stent Retriever: Technical Note

Miyoshi

Shinomiya

Tanaka

et al. 2022

JNET

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Objective: Currently, there are no established approaches for removal of devices, such as stents, which sometimes become difficult to recover during endovascular treatment. We report a new method to successfully remove a stent that has become snagged during thrombus removal.Case Presentation: An 82-year-old female who had undergone a mitral valve annuloplasty developed sudden aphasia, right hemiplegia, and right unilateral spatial neglect on postoperative day 10. Cranial MRI indicated occlusion of the horizontal segment of the left middle cerebral artery. During mechanical thrombectomy, a vasospasm snagged the stent, and re-sheathing attempts failed repeatedly. We wedged the microcatheter into the spasm site and slowly injected a solution containing 1 cc of nicardipine, 2 cc of contrast medium, and 2 cc of heparin in normal saline intra-arterially. After several minutes, we retracted the Trevo wire slightly and easily removed the stent. The thrombus adhered to the retrieved stent. Post-retrieval imaging showed that the branch was completely recanalized. Conclusion:In cases wherein a microwire or stent retriever becomes difficult to remove, we propose switching to a microcatheter with a sufficient diameter to allow vasodilator injection. If the microcatheter is difficult to remove, our method can be utilized by severing the hub, inserting a larger-bore catheter, and injecting vasodilators. Adding contrast medium to the intra-arterial injectate allows visualization of whether the solution has reached the spasm site. Furthermore, by injecting the solution through the wedged catheter, pooling of the solution at the spasm site can be confirmed.

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Section: Discussionmentioning

confidence: 99%