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Simulator Training for Endovascular Neurosurgery
Published on: May 6, 2020
Endovascular Thrombectomy for Distal Occlusion Using a Semi-Deployed Stentriever: Report of 2 Cases and Technical
Yue Wan1, I-Hsiao Yang2,3, Emanuele Orru3
1Department of Neurology, The Third People's Hospital of Hubei, Wuhan, China.
Abstract:
Distal intracranial occlusions can sometimes cause significant neurological deficits. Endovascular thrombectomy in these vessels may improve outcome but carry a higher risk of haemorrhagic complications due to the small calibre and tortuosity of the target vessel. We report two cases of isolated M2/3 artery occlusion causing dense hemiplegia that was successfully treated with stent retrieval thrombectomy. A "semi-deployment technique" of a 3 mm stentriever was employed at the M2/3 bifurcation of the middle cerebral artery. Partial stent unsheathing allowed adequate clot engagement while avoiding excessive tension by the stent metal struts along the tortuous course of a distal vessel. Complete revascularization was achieved after firstpass of the stent retriever without complication, resulting in good clinical outcome in both cases. The described semi-deployment technique reduces the radial and tractional force exerted by the stentreiver on small branches, and may reduce the risk of vessel laceration or dissection in distal vessel thrombectomy.
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