A retrospective study of the Dual-channels Bolus Contrast Injection (Dc-BCI) technique during endovascular mechanical thrombectomy in the management of acute ischemic stroke due to large-vessel occlusion: a technical report

Endovascular mechanical thrombectomy (EMT) is an effective treatment for acute ischemic stroke and identifying the precise thrombus size remains key to a successful EMT. However, no imaging modality has been able to provide this information simultaneously and efficiently in an emergency setting. The present study introduces a novel technique named dual-channel bolus contrast injection (Dc-BCI) for determining thrombus size and location during EMT. In the <i>in vitro</i> study, the Dc-BCI demonstrated an accurate projection of the thrombus size, as the actual thrombus diameter (R² = 0.92, <i>p</i> < 0.01) and length (R² = 0.94, <i>p</i> < 0.01) exhibited a high degree of correlation with that of obtained from Dc-BCI. Consequently, between February 2023 and August 2024, 87 patients diagnosed with acute cerebral large vessel occlusions were enrolled in the study and received EMT for the treatment of acute cerebral large vessel occlusions. The Dc-BCI was successfully performed in all patients to measure the diameter and length of the thrombus. These information were used to select an appropriate stent-retriever for EMT. The restoration of blood flow was achieved in 84 patients (96.6%) to an mTICI score of 2b/3. Additionally, a low incidence of postoperative complications was observed (e.g., subarachnoid hemorrhage 8% and cerebral hemorrhage 5.7%). In conclusion, it can be posited that the Dc-BCI has the potential to enhance the outcomes of EMT, as it is capable of revealing the thrombus size information, which optimizes the interaction between the stent retriever and the thrombus, while simultaneously reducing the risk of vascular injury that is associated with the prolonged use of the stent retriever.