First-line Double Stentriever Thrombectomy for M1/TICA Occlusions : Initial Experiences

Area of Science:

• Neurology
• Interventional Neuroradiology
• Vascular Surgery

Background:

• Mechanical thrombectomy is standard for large-vessel occlusion ischemic stroke but has suboptimal recanalization rates in about one-third of cases.
• Simultaneous dual stentriever use shows promise for treating refractory clots.
• This study evaluates the safety and efficacy of using two stentrievers as a primary treatment for M1 segment middle cerebral artery or terminal internal carotid artery occlusions.

Purpose of the Study:

• To assess the safety and effectiveness of first-line dual stentriever thrombectomy.
• To evaluate outcomes in patients with acute M1 segment middle cerebral artery and/or terminal internal carotid artery occlusions.

Main Methods:

• Prospective single-center study of 39 consecutive patients with M1/TICA occlusion.
• Intervention involved dual stentriever thrombectomy.
• Outcomes measured included recanalization (TICI 2b/3), first-pass effect, procedure time, device passes, symptomatic intracranial hemorrhage, NIHSS, and 90-day functional independence (mRS 0-2) and mortality.

Main Results:

• All 39 patients achieved successful recanalization (TICI 2b/3).
• 69% achieved TICI 2c/3 after the first pass.
• Mean intervention time was 36 minutes; mean device passes were 1.5.
• Symptomatic intracranial hemorrhage occurred in 7.9% of patients.
• At 90 days, 41% of patients were functionally independent, and 23% had died.

Conclusions:

• First-line dual stentriever thrombectomy is a safe and effective strategy for acute M1/TICA occlusions.
• The procedure demonstrates high recanalization rates and acceptable safety profile.
• Further research may support its broader adoption as a primary treatment.