Efficacy of the Dual Stent Retriever Technique for Branching-Site Occlusions in Mechanical Thrombectomy

Mechanical thrombectomy (MT) is an established treatment for acute ischemic stroke due to large vessel occlusion. Although achieving first-pass effect (FPE) is strongly associated with clinical outcomes, branching-site occlusions remain technically challenging and are associated with lower FPE rates. The dual stent retriever (DSR) technique has been proposed to improve thrombus engagement in branching vessel anatomy. This study aimed to evaluate the efficacy and safety of the DSR technique in patients with branching-site occlusions.

We retrospectively reviewed consecutive patients with angiographically confirmed branching-site occlusions who underwent MT between January 2020 and April 2025. Patients were classified according to the first-line thrombectomy strategy into a DSR group or a single SR (SSR) group. We compared the FPE rate, procedural complications, and prognosis between the groups. Furthermore, an adjusted analysis was performed using Firth's penalized logistic regression.

Among 105 eligible patients, 20 were treated with the DSR technique. The rate of FPE was significantly higher in the DSR group than in the SSR group (90.0% vs. 27.1%, p <0.001), whereas procedure time and complications did not differ between groups. After adjustment for relevant confounders, the DSR technique remained independently associated with FPE (adjusted odds ratio [aOR] 38.92, 95% confidence interval [CI] 4.60-329.39, p <0.001) and favorable functional outcome (aOR 4.59, 95% CI 1.03-20.36, p = 0.045).

The DSR technique showed an association with higher rates of first-pass reperfusion in branching-site occlusions without a clear increase in procedural risk, indicating that it may be a feasible option in selected cases, although confirmation in prospective studies is needed.