Parallel Stent Retriever Technique for a Refractory Middle Cerebral Artery Embolism: A Technical Case Report

Area of Science:

• Neurology
• Interventional Neuroradiology
• Vascular Surgery

Background:

• Acute ischemic stroke due to middle cerebral artery (MCA) occlusion is a leading cause of disability.
• Mechanical thrombectomy is a standard treatment, but some cases remain refractory to conventional techniques.
• Recalcitrant emboli in the MCA present significant therapeutic challenges.

Purpose of the Study:

• To present a case of successful recanalization using a novel parallel stent retriever (SR) technique.
• To evaluate the feasibility of the parallel SR technique for refractory acute MCA embolism.
• To highlight an alternative treatment strategy for complex MCA occlusions.

Main Methods:

• An 86-year-old female patient with acute right MCA occlusion underwent multiple failed thrombectomy attempts with a single SR.
• A modified technique involved the simultaneous deployment of two SRs in parallel within the MCA's M1 segment.
• The parallel SRs were retrieved together to extract the thrombus.

Main Results:

• Complete recanalization of the MCA was achieved after the parallel SR technique was applied.
• The patient's refractory embolism was successfully treated with this innovative approach.
• The procedure demonstrated the efficacy of the parallel SR technique in a challenging clinical scenario.

Conclusions:

• The parallel stent retriever technique is a viable and effective method for treating refractory acute MCA embolisms.
• This technique can be considered a valuable last resort for complex MCA occlusions.
• Further studies are warranted to establish the broader applicability of the parallel SR technique.