Dual SAVE technique for mechanical thrombectomy rescue on MCA bifurcation clots

Area of Science:

• Neurology
• Interventional Neuroradiology
• Vascular Surgery

Background:

• Mechanical thrombectomy is a key treatment for acute ischemic stroke.
• The Stent retriever Assisted Vacuum-locked Extraction (SAVE) technique offers high first-pass reperfusion rates.
• Complex occlusions, such as tandem internal carotid artery and middle cerebral artery (MCA) blockages, pose challenges for standard thrombectomy.

Purpose of the Study:

• To describe the novel D-SAVE technique.
• To present the combined use of SAVE and double stent-retriever techniques as a rescue strategy for challenging tandem occlusions.

Main Methods:

• The D-SAVE technique involves simultaneous use of a stent retriever and distal aspiration catheter (SAVE).
• A double stent-retriever technique was employed as a rescue strategy for clot instability.
• This combined approach was utilized in a patient with tandem internal carotid artery and distal MCA occlusion.

Main Results:

• The D-SAVE technique was successfully applied as a rescue strategy.
• This approach addressed the challenges of non-trapped thrombus and risk of distal embolization.
• The case demonstrated the feasibility of combining SAVE with a double stent-retriever technique.

Conclusions:

• The D-SAVE technique is a viable rescue strategy for complex tandem occlusions.
• Combining SAVE and double stent-retriever methods can overcome limitations of standard thrombectomy.
• This approach may improve outcomes in challenging stroke cases.