Mechanical Thrombectomy with Stent Retriever 29 Days After Onset of Ischemic Stroke.

A patient presented with progressive ischemic stroke and received mechanical thrombectomy with a Solitaire FR device 29 days after stroke onset. The occluded V4 segment of the left vertebral artery showed a double rail sign on angiography, which indicated that the occlusion might have been caused by embolism instead of stenosis. The mechanical thrombectomy procedure was a 1-pass success and the patient was functionally independent with a modified Rankin Scale score of 1 at 3-month follow-up. The appearance of the vascular wall (double rail sign) of the occluded cerebral vascular segment on angiography may be a significant feature to identify the character of the occlusion even a long time after onset, which is important when planning further endovascular therapy in patients with ischemic stroke.