Preventing Embolization to a New Vascular Territory: An in Vitro Study Exploring Alternative Techniques for Dual-Stent-Retriever Cerebral Thrombectomy.

OBJECTIVE

Embolization of thrombus to a new vascular territory (ENT) is a feared and important complication of cerebral thrombectomy in acute ischemic stroke. This study explores the utilization of 2 simultaneous stent retrievers to prevent ENT, as well as its alternative setups.

METHODS

An in vitro glass model with a unilateral anterior cerebral vasculature was used to recreate a challenging scenario that intrinsically facilitates ENT. Four different thrombectomy techniques were tested and compared across a total of 50 in vitro procedures: Technique [1]-single stent retriever; Techniques [2] and [3]-dual stent retrievers with asymmetric and symmetric stent retrieval, respectively; and Technique [4]-dual stent retrievers combined with distal aspiration. The success rate and time to perform the procedures were compared using the Fisher's exact test and Mann-Whitney U test, respectively.

RESULTS

The collective performance of dual-stent techniques [2 + 3 + 4] yielded successful recanalization on 1st pass without ENT in 24/30 cases (80%), which was statistically significantly better than the 8/20 (40%) achieved with the single-stent technique [1] (p = 0.006). The dual stent retrievers combined with an aspiration catheter [4] performed best, yielding successful recanalization on 1st pass without ENT in 10/10 cases (100%), which was also statistically significantly better compared to the single-stent technique [1] (p = 0.002). All other possible comparisons across the different techniques did not yield any statistically significant differences.

CONCLUSION

Overall, the results suggest that applying dual stent retrievers performs better than the single-stent-retrieval technique in preventing ENT and achieving a single-pass procedure. Among all techniques, combining dual stent retrievers with aspiration through a distal catheter performed best.