Technical note on endovascular treatment of concomitant carotid occlusion in large vessel occlusion stroke: The “single-cross” technique

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> Emergent large vessel occlusive (ELVO) stroke secondary to underlying carotid occlusive disease is frequently encountered in endovascular ischemic stroke therapy and trials. Up to 29% of all cerebral vascular accidents are attributed to severe carotid occlusive disease, and recent interventional trials have demonstrated this occurrence in 18.6–32.2% of ELVO stroke. We present a novel technique using the stent retriever guide wire to expedite angioplasty and/or stent placement for associated carotid occlusive disease during mechanical thrombectomy of ELVO stroke. This technique utilizes the “waiting time” during stent retriever integration within the thrombus as an opportunity to initiate revascularization of the cervical carotid, using the deployed stent retriever guidewire as an ad hoc rapid exchange wire while the stentriever serves as a potential surrogate distal embolic protection device. We present 23 cases using this novel endovascular approach, which we have called the single-cross technique, as the cervical lesion is only traversed once during therapy. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A case series of 23 consecutive patients who underwent a novel endovascular technique for treating tandem ICA origin and intracranial occlusive lesions is presented. Endpoints measured were time to re-perfusion, rates of intracranial hemorrhage and clinical outcomes (mRS at 30 and 90 days). </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Average procedure time for revascularizing both the carotid and intracranial lesions was 52 min. A symptomatic ICH rate of 9% was observed. Seventy-four percent of patients had an mRS of 0–2 at follow-up. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> The single-cross technique appears to be a safe and effective option for treating tandem occlusive lesions in the setting of ELVO. </jats:p></jats:sec>

Novel use of a closed-tip stent retriever to prevent distal embolism in the posterior circulation: illustrative case

“…Several reports of open-tip stent retrievers have been effectively used as distal EPDs in tandem lesions of the anterior circulation. 7,8 A stent retriever, especially EmboTrap, a closed-tip stent retriever, may have several advantages over filter devices when used as an EPD in the posterior circulation. EmboTrap is a stent retriever with the unique structure of a foldable outer cage combined with an inner channel, and the indicated vessel size is down to a minimum of 1.5 mm so filters cannot be placed.…”