A Novel Technique to Retrieve a Snagged Stent Retriever: Technical Note.

Area of Science:

• Endovascular therapy
• Neurointerventional procedures
• Vascular surgery

Background:

• Device retrieval during endovascular procedures can be challenging.
• Stent retrievers may become snagged due to vasospasm or anatomical factors.
• Current methods for managing difficult device removal are limited.

Purpose of the Study:

• To present a novel technique for the successful removal of a difficult-to-retrieve stent during endovascular treatment.
• To describe a method for managing intraprocedural vasospasm that impedes device removal.
• To report a case of successful stent retrieval using intra-arterial vasodilator injection.

Main Methods:

• A microcatheter was wedged into a vasospasm site causing stent snagging during mechanical thrombectomy.
• An intra-arterial solution of nicardipine, contrast medium, and heparin in normal saline was slowly injected.
• The stent retriever was then easily retracted after vasodilation was confirmed via contrast visualization.

Main Results:

• The technique successfully facilitated the removal of a snagged stent retriever.
• Intra-arterial vasodilator injection resolved the vasospasm, allowing for device retrieval.
• Post-retrieval imaging confirmed complete recanalization of the affected cerebral artery branch.
• The retrieved stent successfully removed the adhered thrombus.

Conclusions:

• Intra-arterial vasodilator injection via a microcatheter is an effective method for managing difficult stent retriever removal during endovascular procedures.
• This technique can be utilized when standard re-sheathing attempts fail due to vasospasm.
• The addition of contrast medium aids in confirming accurate delivery and effectiveness of the vasodilator at the target site.