Retriever wire supported carotid artery revascularization (ReWiSed CARe) in acute ischemic stroke with underlying tandem occlusion caused by an internal carotid artery dissection: Technical note

Abstract

We hereby report a novel technical approach for the treatment of acute stroke with underlying tandem occlusion. The so-called retriever wire supported carotid artery revascularization (ReWiSed CARe) technique, utilizing the wire of a stent-retriever as a guiding wire for carotid artery stenting, is technically feasible in tandem occlusions caused by an internal carotid artery (ICA) dissection or high grade ICA stenosis. This technique eliminates the need to use a long microwire in order to maintain the position inside the true lumen of a dissection. Additionally, it leads to anterograde perfusion through the released stent-retriever during the time of ICA stenting, which is favorable in all tandem occlusion cases.

Keywords: Carotid artery dissection; carotid artery stenting; stroke.

Figure 1.

Computed tomographic imaging to TICI2b: (a) coronal reformatted images showing a carotid-T and an ipsilateral ICA occlusion; (b) injection into the left common carotid depicts a proximal occlusion of the ICA; (c) after passage of the dissection a microcatheter injection verified the true lumen (distal M2); (d) after deployment of the stent-retriever (arrows) the carotid stent was placed over the stent-retriever wire (dotted arrows); (e) control injection after one passage with the stent-retriever showing a persistent occlusion of the M1 segment and a good reconstruction of the ICA; (f) final angiogram showing a TICI2b result.