Resolving distal vessel occlusions caused by migrated emboli utilizing a modified stent retrieval technique

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-05-18 DOI:10.1016/j.clineuro.2025.108957

Hong Suk Ahn , Jung Hyun Park , Jun Hyong Ahn , Hong Jun Jeon , Byung Moon Cho

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Abstract

Background

We retrospectively evaluated the safety and effectiveness of a modified stent retrieval technique that controls the unsheathing level of the microcatheter in resolving distal vessel occlusions resulting from migrated emboli.

Methods

From January 2016 to February 2022, a modified stent retrieval technique was applied to 24 of 445 patients with acute large vessel occlusion stroke in the anterior circulation, featuring secondary embolus migration into M2, M3, A2, or A3 branches. The coverage range was adjusted through partial re-sheathing of the stent retriever by the delivery microcatheter after full unsheathing. Primary and secondary recanalization rates were assessed using the modified thrombolysis in cerebral infarction (TICI) score.

Results

After recanalizing the primary large vessel occlusions, secondary distal vessel occlusions occurred in 12, 6, 4, and 2 patients in the M2, M3, A2, and A3 branches, respectively. The modified TICI score was 2a and 2b in 8 and 16 patients, respectively, for primary large vessel occlusion. The first pass rate of secondary distal vessel occlusions was 70.8 %, and 23 of 24 patients achieved a final recanalization rate of at least TICI 2c at the migrated distal vessel occlusion (mean duration: 23.2 ± 14 min) without significant complications. At 3 months, 16 patients (66.7 %) achieved favorable functional outcomes (modified Rankin score, 0–2).

Conclusion

This simple, effective, modified technique demonstrated safety and efficacy in resolving distal vessel occlusion.

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利用改良的支架回收技术解决由迁移栓塞引起的远端血管闭塞

背景：我们回顾性评估了一种改良的支架取出技术的安全性和有效性，该技术可以控制微导管的脱鞘水平，以解决由迁移栓塞引起的远端血管闭塞。方法2016年1月至2022年2月，对445例急性前循环大血管闭塞性卒中患者中的24例应用改良支架置入术，这些患者继发性栓塞迁移至M2、M3、A2、A3支。覆盖范围的调整是在完全脱鞘后，通过输送微导管对支架回收器进行部分复鞘。采用改良的脑梗死溶栓（TICI）评分评估原发性和继发性再通率。结果原发性大血管闭塞再通后，继发远端血管闭塞分别发生M2、M3、A2、A3支12例、6例、4例和2例。原发性大血管闭塞的改良TICI评分分别为8例2a和16例2b。继发性远端血管闭塞的一次通过率为70.8 %，24例患者中有23例在迁移性远端血管闭塞时达到TICI 2c以上的最终再通率（平均持续时间：23.2 ± 14 min），无明显并发症。3个月时，16例患者（66.7 %）获得良好的功能结局（修正Rankin评分，0-2）。结论：这种简单、有效、改良的方法治疗远端血管闭塞安全有效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.