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Hofmeister J, Brina O, Bernava G, Rosi A, Reymond P, Lovblad KO, Machi P. Double Stent Retriever Technique for Mechanical Thrombectomy: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2024; 45:1031-1037. [PMID: 38521091 DOI: 10.3174/ajnr.a8253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Mechanical thrombectomy using a double stent retriever technique has recently been described for the treatment of acute ischemic stroke, but its efficacy and safety are not well-established. PURPOSE The aim of this systematic review and meta-analysis was to evaluate reports of the use of a double stent retriever technique during the endovascular treatment of patients with ischemic stroke. DATA SOURCES The PubMed, EMBASE, Web of Science, and Scopus databases were searched to identify all studies (clinical trials, cohort series, and case reports) investigating the utility of a double stent retriever technique for the treatment of stroke. The study is reported in accordance with PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD42023482691). STUDY SELECTION Seventeen studies involving a total of 128 patients with large-vessel occlusions predominantly in the anterior circulation (93.0%) were identified. DATA ANALYSIS Outcomes of interest were the prevalence of successful recanalization (modified TICI ≥2b) and a first-pass effect following the double stent retriever technique as well as complications such as iatrogenic dissections and SAH. Data were pooled using a random effects model. DATA SYNTHESIS The double stent retriever technique was used as a rescue strategy in occlusions refractory to conventional endovascular treatment in 68.7% (88/128) of patients and as a first-line strategy in 31.3% (40/128) of patients. The double stent retriever technique achieved an overall final modified TICI ≥2b in 92.6% cases, with a first-pass effect of 76.6%. The complication rate remained low, with 0.37% dissection and 1.56% SAH. LIMITATIONS Limitations of the study include the following: 1) a large number of case reports or small series, 2) a meta-analysis of proportions with no statistical comparison with a control group, and 3) the lack of access to patient-level data. CONCLUSIONS Our findings suggest that double stent retriever thrombectomy may be safe and associated with good recanalization outcomes, but prospective comparative studies are needed to determine which patients may benefit from this endovascular procedure.
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Affiliation(s)
- Jeremy Hofmeister
- From the Department of Diagnostics (J.H., O.B., G.B., A.R., P.R., K.-O.L., P.M.), Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
- Brain Endovascular Therapeutics Research and Development Lab (J.H., O.B., P.R., K.-O.L., P.M.), Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Olivier Brina
- From the Department of Diagnostics (J.H., O.B., G.B., A.R., P.R., K.-O.L., P.M.), Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
- Brain Endovascular Therapeutics Research and Development Lab (J.H., O.B., P.R., K.-O.L., P.M.), Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Gianmarco Bernava
- From the Department of Diagnostics (J.H., O.B., G.B., A.R., P.R., K.-O.L., P.M.), Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Andrea Rosi
- From the Department of Diagnostics (J.H., O.B., G.B., A.R., P.R., K.-O.L., P.M.), Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
| | - Philippe Reymond
- From the Department of Diagnostics (J.H., O.B., G.B., A.R., P.R., K.-O.L., P.M.), Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
- Brain Endovascular Therapeutics Research and Development Lab (J.H., O.B., P.R., K.-O.L., P.M.), Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Karl-Olof Lovblad
- From the Department of Diagnostics (J.H., O.B., G.B., A.R., P.R., K.-O.L., P.M.), Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
- Brain Endovascular Therapeutics Research and Development Lab (J.H., O.B., P.R., K.-O.L., P.M.), Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Paolo Machi
- From the Department of Diagnostics (J.H., O.B., G.B., A.R., P.R., K.-O.L., P.M.), Diagnostic and Interventional Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
- Brain Endovascular Therapeutics Research and Development Lab (J.H., O.B., P.R., K.-O.L., P.M.), Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
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Byer SH, Madarang EJ, Abraham MG. Dual-Stent retriever thrombectomy for extensive dural sinus thrombosis. Int J Neurosci 2023; 133:1374-1379. [PMID: 35593753 PMCID: PMC9744960 DOI: 10.1080/00207454.2022.2080675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 05/12/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION First line treatment for cerebral venous thrombosis (CVT) is systemic anticoagulation. In cases with symptoms of elevated ICP, endovascular thrombectomy (EVT) is pursued. We describe two cases in which dual stent-retrievers were used for EVT. OBJECTIVES The use of dual stent-retrievers has been described in arterial stroke when clot is present in the M1 artery and both M2 branches as a rescue therapy after 1 stent-retriever failed to remove the clot. We applied this same thinking to our EVT patients. METHODS A 17-year-old female with imaging demonstrating occlusion of the superior sagittal sinus (SSS), dominant right transverse sinus (TS), right sigmoid sinus (SS), and upper right internal jugular vein (IJV). A 20-year-old female with a magnetic resonance venography (MRV) noting CVT in the dominant lateral left TS, SS, and upper left IJV. RESULTS Both were taken for EVT due to severity of symptoms. Two 6 × 40 mm stent-retrievers were deployed into the CVT and then remove with continuous aspiration with significant recanalization. CONCLUSIONS The average diameter of the dural sinuses is 8 mm compared to the average size of the middle cerebral artery 3-4 mm. The largest available SR in the United States is 6 mm, and the largest outer diameter of available aspiration catheters is 2-3 mm. Due to the larger size of the dural sinuses, using two SRs can result in more efficient recanalization and less radiation.
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Affiliation(s)
- Stefano H. Byer
- Department of Neurology, University of Kansas Medical Center
| | | | - Michael G. Abraham
- Department of Neurology, University of Kansas Medical Center
- Department of Radiology, University of Kansas Medical Center
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Alwahdy AS, Dongoran RA. Double stent retriever technique for rescue recanalization in refractory large vessel occlusions. Radiol Case Rep 2023; 18:2860-2863. [PMID: 37334327 PMCID: PMC10275971 DOI: 10.1016/j.radcr.2023.05.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
Acute ischemic stroke patients with large vessel occlusion (LVO) involving bifurcation usually have a difficult and high clot burden. By using conventional technique often resulting in a reduction in the possibility of successful recanalization. The double stent retriever technique can be considered for rescue recanalization. We reported a case of refractory terminal left internal carotid occlusion that was treated using double stent retriever technique. Two microcatheter were advanced across the occlusion were one to the superior branch of middle cerebral artery and another was on inferior branch. Both stent retrievers were pulled back together and complete recanalization was achieved. This technique were reported in some case series to be effective and based on our initial experience using this technique it seems the expansion improved after deployment of the second stent retriever and it traps the clot within its stent struts, to facilitate clot retrieval. Therefore, double stent retriever technique can be one of the choices for rescue recanalization in refractory clot occlusion and it may potentially help other clinicians in similar situations.
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Affiliation(s)
- Ahmad Sulaiman Alwahdy
- Department of Neurology, Interventional Neurology Subdivision, Fatmawati Central General Hospital, RS. Fatmawati Raya Street No.4, South Jakarta, 12430, Indonesia
| | - Rifka Annisa Dongoran
- Faculty of Medicine, University of UIN Syarif Hidayatullah, South Tangerang, Banten, Indonesia
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Lehnen NC, Paech D, Zülow S, Bode FJ, Petzold GC, Radbruch A, Dorn F. First Experience with the Nimbus Stentretriever. Clin Neuroradiol 2022; 33:491-497. [DOI: 10.1007/s00062-022-01237-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022]
Abstract
Abstract
Purpose
To share our first experience with the Nimbus stentretriever, a multizone device designed to assist neurointerventionalists in handling fibrin-rich clots in endovascular stroke treatment.
Methods
We retrospectively analyzed the data of patients who were treated with the Nimbus stentretriever at our high-volume stroke center between May 2021 and May 2022. We evaluated the number of passes before Nimbus was used, the number of passes with nimbus, as well as the recanalization success before and after Nimbus according to the modified treatment in cerebral ischemia (mTICI) scale. Also, patient characteristics, procedural times and clinical outcomes were documented.
Results
A total of 21 consecutive patients were included in the study. An mTICI 2b/3 could be achieved in 76.2% and mTICI 2c/3 could be achieved in 57.1%. The mean number of passes was 3.4 before the use of Nimbus, 2.2 with Nimbus, and 5.4 for all passes with and without Nimbus and 4 occlusions (19.0%) were successfully recanalized with direct aspiration after the use of Nimbus. We observed seven subarachnoid hemorrhages (33.3%) and two cases of vasospasm.
Conclusion
In our series, the use of Nimbus resulted in successful recanalization in half of the patients after otherwise unsuccessful thrombectomy maneuvers; therefore, it should be considered as a rescue option if the maneuver with conventional stent retrievers was unsuccessful.
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