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Ischemic Stroke
Case series
Crossing Y-Solitaire thrombectomy as a rescue treatment for refractory acute occlusions of the middle cerebral artery
  1. Kubilay Aydin1,2,
  2. Mehmet Barburoglu2,
  3. Ozgur Oztop Cakmak3,
  4. Nilufer Yesilot4,
  5. Ebru Nur Yavuz Vanli3,
  6. Sergin Akpek5
  1. 1 Department of Neuroradiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
  2. 2 Department of Radiology, Interventional Neuroradiology Unit, Koc University School of Medicine, Koc University Hospital, Istanbul, Turkey
  3. 3 Department of Neurology, Koc University School of Medicine, Koc University Hospital, Istanbul, Turkey
  4. 4 Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
  5. 5 Department of Radiology, VKV American Hospital, Istanbul, Turkey
  1. Correspondence to Professor Kubilay Aydin, Department of Neuroradiology, Istanbul University, IstanbulFaculty of Medicine, Istanbul 34452, Turkey; dr.aydink{at}gmail.com

Abstract

Background Mechanical thrombectomy using a stent retriever has become the standard of care for acute large-vessel occlusions in the anterior circulation. Clots that are refractory to single stent retriever thrombectomy remain a challenge for neurointerventionalists.

Objective To assess the efficacy and safety of double stent retriever (crossing Y-Solitaire) thrombectomy as a rescue treatment for acute middle cerebral artery (MCA) occlusions that are refractory to single stent retriever thrombectomy.

Methods We retrospectively reviewed the databases of our hospitals to identify patients who presented with an acute MCA occlusion and were treated with crossing Y-Solitaire thrombectomy. The angiographic (Thrombolysis in Cerebral Infarction (TICI) scale) and clinical outcomes (National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores) and complications were assessed.

Results Ten patients were included in the study. The median initial NIHSS score and Alberta Stroke Program Early CT Score (ASPECTS) were 19.0 and 9.6, respectively. Crossing Y-Solitaire thrombectomy was performed as a rescue technique after unsuccessful single Solitaire thrombectomy passes in all cases. Successful recanalization (TICI 2b/3) was achieved in 8 (80%) patients. We observed asymptomatic reperfusion hemorrhages in 2 (20%) patients. No procedural related complications were seen other than reversible vasospasms in 5 (50%) patients. Sixty percent of the patients had a mRS score of between 2 and 0 at 90 days after the procedure. There was no mortality.

Conclusion Crossing Y-Solitaire thrombectomy seems to be an effective and safe alternative rescue technique to treat refractory MCA bifurcation occlusions that are refractory to standard thrombectomy procedures.

  • stroke
  • thrombectomy
  • intervention

https://doi.org/10.1136/neurintsurg-2018-014288

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    Footnotes

    • Contributors All authors contributed to the manuscript through data collection, analysis, manuscript composition, and critical review.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Istanbul Medical School local ethics.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement N/A. There are no unpublished data.