Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Mar 19;100(11):e24993.
doi: 10.1097/MD.0000000000024993.

Y-configuration double-stent-retriever thrombectomy for refractory thrombus in middle cerebral artery bifurcation: A case report

Changchun Jiang  1 , Yuechun Li, Fei Hao, Junfeng Yang, Baojun Wang, Yu Fan
Affiliations
Case Reports

Y-configuration double-stent-retriever thrombectomy for refractory thrombus in middle cerebral artery bifurcation: A case report

Changchun Jiang et al. Medicine (Baltimore). .

Abstract

Rationale: Stent retriever mechanical thrombectomy is a recommended treatment for acute ischemic stroke. However, refractory thrombus in artery bifurcation can reduce the rate of successful revascularization.

Patient concerns: A 72-year-old male, owing to the acute onset of almost complete right-sided hemiplegia and global aphasia, received bridging therapy. National Institutes of Health Stroke Scale score was 16 at the time of admission.

Diagnoses: Cerebral digital subtraction angiography revealed occlusion of the M1 segment of the left MCA.

Interventions: Thrombectomy with 3 passes of the Solitaire FR device (Medtronic, Minneapolis, MN) was unsuccessful. Two stent retrievers were inserted in parallel by one microcatheter access point to each M2 branch, and then both stents were gradually retrieved out of the catheter while continuous suction was maintained.

Outcomes: After thrombectomy, subsequent follow-up angiograms showed mTICI 3 reperfusion of MCA. The patient has mRS 2 at discharge and the 3-month mRS score after stroke is 1 score.

Lessons: The presented Y-configuration double-stent-retriever thrombectomy technique constitutes a safe and effective rescue treatment method for refractory thrombus in MCA bifurcation.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interests to disclose.

Figures

Figure 1
Figure 1
(A) Aortic arch angiography showing that the left proximal common carotid artery was severely tortuous. (B) A frontal angiogram showing an occluded left MCA. (C) Thrombectomy with 3 passes of the Solitaire FR was unsuccessful; arrowheads show the left MCA bifurcation clot. (D) Anteroposterior image showing the Solitaire FR 4 × 15 stent retriever (arrow) in the superior MCA trunk; the proximal end of the stent did not cover the bifurcation. (E) Anteroposterior image showing the kissing-Y stent technique. (F) Frontal angiogram showing complete recanalization of the left MCA.
See this image and copyright information in PMC

References

    1. Berkhemer OA, Fransen PSS, Beumer D, et al. . A Randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11–20. - PubMed
    1. Goyal M, Demchuk AM, Menon BK, et al. . Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015;372:1019–30. - PubMed
    1. Saver JL, Goyal M, Bonafé A, et al. . Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015;372:2285–95. - PubMed
    1. Jovin TG, Chamorro A, Cobo E, et al. . Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015;372:2296–306. - PubMed
    1. Campbell BCV, Mitchell PJ, Kleinig TJ, et al. . Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015;372:1009–18. - PubMed

Publication types

MeSH terms