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SNIS 20th annual meeting electronic poster abstracts
E-067 Use of double-barrel stent retrievers with direct focal aspiration at bifurcation occlusions: the first report of two cases
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  1. B Meyer1,
  2. J Campos2,
  3. D Zarrin3,
  4. M Khan4,
  5. J Collard de Beaufort5,
  6. G Amin4,
  7. K Golshani2,
  8. N Beaty6,
  9. M Bender7,
  10. G Colby3,
  11. L Lin4,
  12. A Coon4
  1. 1University of Arizona College of Medicine, Tucson, Tucson, AZ, USA
  2. 2Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA
  3. 3Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
  4. 4Carondelet Neurological Institute, St. Joseph’s Hospital, Tucson, AZ, USA
  5. 5Syracuse University, Syracuse, NY, USA
  6. 6Florida State University, Tallahassee Memorial Hospital, Tallahassee, FL, USA
  7. 7Department of Neurosurgery, University of Rochester, Rochester, NY, USA

Abstract

Introduction/Purpose Bifurcation occlusions treated with mechanical thrombectomy are more prone to fragmentation on retrieval and are associated with lower recanalization rates in current literature. Simultaneous double stent retriever (SR) techniques were first utilized for rescue use in refractory occlusions, and small-volume case series have since proposed double-SR techniques with BGCs to maximize first-attempt pass results in bifurcation occlusions. To our knowledge, we present the first cases of double-SR thrombectomy with direct focal aspiration utilizing a large-bore catheter.

Materials and Methods Two cases utilizing first-line double-SR thrombectomy with focal aspiration were isolated from a prospectively maintained IRB-approved institutional database and analyzed (January to March 2023).

Results A 75-year-old woman on apixaban for atrial fibrillation presented with a right M1/M2 junction occlusion (NIHSS 7, case A) and the other case (B) was a 72-year-old on apixaban for prior deep venous thrombosis who presented with a left ICA occlusion (NIHSS 12). Thrombectomy was performed with coaxial access system consisting of a large-bore guide catheter (Zoom88/71, Imperative Care, Campbell, CA), AXS Offset delivery assist catheter, and a Trevo Trak 21 microcatheter (Stryker Neurovascular, Fremont, California) over a guidewire in both cases. In Case A, a 4x28-mm Trevo retriever (Stryker) was deployed in the inferior MCA division and Tigertriever 13 (Rapid Medical, Yokneam, Israel) deployed in the superior MCA division. In Case B, a 6-mm Trevo retriever was deployed in the ACA and another 6-mm Trevo retriever in the MCA. In each case, the double-SR configuration was captured through the large-bore catheter under direct focal aspiration. The deployment of dual stentretrievers with aspiration was successful in both cases without evidence of periprocedural complications. First-pass immediate follow-up angiography demonstrated TICI3 reperfusion without evidence of distal emboli. Follow-up imaging did not reveal any new areas of ischemia. NIHSS had improved from 7 to 0 (case A) and from 12 to 2 (case B) at discharge.

Conclusion We present the first cases of first attempt double-SR thrombectomy under direct focal aspiration with a large-bore catheter for bifurcation occlusions achieving full recanalization. Prospective comparative studies in bifurcation occlusions are warranted.

Abstract E-067 Figure 1
Abstract E-067 Figure 1

72-year-old with metastatic lung cancer and intracranial metastases, on apixaban for DVT, presented with a left ICA occlusion. (A) Deployment of double-barrel stentrievers within the ICA and MCA. (B) Follow-up angiography demonstrating full recanalization

Disclosures B. Meyer: None. J. Campos: None. D. Zarrin: None. M. Khan: None. J. Collard de Beaufort: None. G. Amin: None. K. Golshani: None. N. Beaty: 2; C; Medtronic Neurovascular, Stryker Neurovascular. 5; C; CMO of NeuroMedica. M. Bender: 2; C; Stryker Neurovascular. G. Colby: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular. L. Lin: 2; C; Medtronic Neurovascular, Stryker Neurovascular, MicroVention-Terumo, Rapid Medical, Balt. A. Coon: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular, Rapid Medical, Avail MedSystems, Imperative Care, InNeuroCo, Q’apel, Sequent Medical.

https://doi.org/10.1136/jnis-2023-SNIS.167

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