Resolving distal vessel occlusions caused by migrated emboli utilizing a modified stent retrieval technique

We retrospectively evaluated the safety and effectiveness of a modified stent retrieval technique that controls the unsheathing level of the microcatheter in resolving distal vessel occlusions resulting from migrated emboli.

From January 2016 to February 2022, a modified stent retrieval technique was applied to 24 of 445 patients with acute large vessel occlusion stroke in the anterior circulation, featuring secondary embolus migration into M2, M3, A2, or A3 branches. The coverage range was adjusted through partial re-sheathing of the stent retriever by the delivery microcatheter after full unsheathing. Primary and secondary recanalization rates were assessed using the modified thrombolysis in cerebral infarction (TICI) score.

After recanalizing the primary large vessel occlusions, secondary distal vessel occlusions occurred in 12, 6, 4, and 2 patients in the M2, M3, A2, and A3 branches, respectively. The modified TICI score was 2a and 2b in 8 and 16 patients, respectively, for primary large vessel occlusion. The first pass rate of secondary distal vessel occlusions was 70.8 %, and 23 of 24 patients achieved a final recanalization rate of at least TICI 2c at the migrated distal vessel occlusion (mean duration: 23.2 ± 14 min) without significant complications. At 3 months, 16 patients (66.7 %) achieved favorable functional outcomes (modified Rankin score, 0-2).

This simple, effective, modified technique demonstrated safety and efficacy in resolving distal vessel occlusion.