Stent Retriever Assisted Endoluminal Reconstruction (STARecon) in Interventional Stroke Management

Endovascular stroke treatment has become the standard of care for acute large vessel occlusion and has significantly improved clinical outcomes. However, the procedure is still associated with possible complications, including vessel injury and reocclusion. This monocentric retrospective observational cohort study aims to evaluate the outcomes of the STent retriever Assisted endoluminal Reconstruction (STARecon) technique. In this case series we propose temporary deployment of a stent retriever as a potential bailout strategy in situations of spontaneous vessel reocclusion or uncertain vessel narrowing not associated with intracranial atherosclerotic disease (ICAD), including suspected iatrogenic dissection.

Eight cases of temporary stenting using STARecon technique with stent retriever to treat spontaneous vessel reocclusion after thrombectomy were analysed. All patients underwent pre- and postinterventional non-invasive angiographic imaging (CTA or MRA) and clinical evaluation. The endovascular technique involved temporary deployment of a stent retriever under glycoprotein IIb/IIIa inhibitor infusion, followed by antithrombotic medication after atraumatic resheathing and removal of the stent retriever.

Successful vessel recanalization was achieved in all cases with the duration of temporary stenting using stent retriever between 15 and 50 min (average 30 min 37 s). Postinterventional follow-up imaging demonstrated resolution of the spontaneous reocclusion without significant residual stenosis in all the cases at the treated site with STARecon technique.

Our findings suggest that temporary stent retriever deployment using the STARecon technique may represent a valuable alternative to stent reconstruction in endovascular management of spontaneous vessel reocclusion after thrombectomy, including suspected iatrogenic dissection, especially in patients deemed at high risk of intracranial hemorrhage.