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Case series
Tandem stents thrombectomy as a rescue treatment for refractory large vessel occlusions
  1. Haowen Xu1,
  2. Shanling Peng2,
  3. Tao Quan1,
  4. Yongjie Yuan1,
  5. Zibo Wang1,
  6. Xiaojie Fu1,
  7. Kaihao Han1,
  8. Guo Liu1,
  9. Sheng Guan1,
  10. Panxing Li1
  1. 1 Department of Neurointerventional Radiology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
  2. 2 Department of Emergency, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
  1. Correspondence to Dr Panxing Li, Department of Neurology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China; 15617878639{at}


Background Mechanical thrombectomy with a stent retriever (SR) and/or aspiration is the 'gold standard' for the treatment of acute ischemic stroke due to large vessel occlusion (LVO). However, sometimes clots may not be retrievable with a single SR alone or combined with aspiration.

Objective To assess the safety and efficacy of a novel tandem stents thrombectomy (TST) technique as a rescue treatment for acute LVO that is refractory to conventional attempts.

Methods All patients treated with the TST technique as rescue treatment after failure of conventional attempts were retrospectively reviewed. The postprocedural angiographic and clinical outcome, including modified Thrombolysis in Cerebral infarction (mTICI) grade, National Institutes of Health Stroke Scale (NIHSS) score, and modified Rankin Scale (mRS) score, was assessed.

Results Nine patients (mean age, 65.2 years; median NIHSS score 18) with middle cerebral artery M1 segment (n=6) and terminal internal carotid artery (n=3) occlusions were included in the study. The TST technique was performed as a rescue treatment after unsuccessful stent thrombectomy alone (four cases) and stent thrombectomy plus aspiration (five cases). Successful recanalization (mTICI 2b/3) was achieved in all patients. No procedure-related complications occurred except reversible vasospasms were observed in three patients and one patient developed hemorrhage transformation after the procedure, but was asymptomatic. Three patients had good clinical outcome (mRS score 0–2 at 90 days). Two patients (22.2%) died.

Conclusions The TST technique seems to be a safe and effective rescue treatment for acute LVO that is refractory to conventional attempts.

  • thrombectomy
  • technique
  • stroke
  • stent

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  • Contributors HX, SG, and PL: study conception, design, data acquisition, interpretation, and drafting the manuscript and critically revising it. SP, TQ, YY, ZW, XF, KH, and GL: contributed to data acquisition and critical revisions of the manuscript. All authors have approved the final manuscript and are accountable for all aspects of the work.

  • 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 for publication Not required.

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