Y-Configuration Dual Stent Retriever Thrombectomy for Bifurcation Occlusions in Acute Ischemic Stroke

Bifurcation occlusions present unique technical challenges during mechanical thrombectomy. We evaluated the angiographic, clinical, and safety outcomes of Y-configuration dual stent retriever thrombectomy in patients with acute ischemic stroke caused by bifurcation occlusions.

We retrospectively analyzed 32 consecutive patients treated with Y-configuration dual stent retriever thrombectomy between April 2018 and January 2025. The technique was used as a rescue strategy after failed single-device attempts or as a first-line approach in selected bifurcation occlusions. Angiographic outcomes, procedural metrics, complications, and 90-day clinical outcomes were assessed.

The middle cerebral artery was the most common occlusion site (81.3%). Successful reperfusion (TICI ≥2b) was achieved in 97% of patients, with complete reperfusion (TICI 3) in 91% of cases. Following the first Y-configuration thrombectomy attempt, successful reperfusion (TICI ≥2b) was achieved in 87% of cases, irrespective of prior thrombectomy attempts. Median NIHSS improved from 16 at baseline to 7 at 24 hours. At 90 days, 53% of patients achieved functional independence (mRS ≤2). Symptomatic intracranial hemorrhage occurred in 6.3%; any intracranial hemorrhage occurred in 9.4%, and no vasospasm, vessel dissection, device-related perforation, or subarachnoid hemorrhage was observed.

Y-configuration dual stent retriever thrombectomy appears feasible as a rescue option for selected complex bifurcation occlusions refractory to conventional thrombectomy. Prospective comparative studies are needed to further establish its safety, efficacy, and optimal indications.