The “Stentriever Sandwich” Technique: Management of Stent Retriever Entrapment after Carotid Stenting in Tandem Stroke

Tandem large-vessel occlusion refers to simultaneous occlusion of a major intracranial and extracranial artery. Endovascular treatment of tandem lesions presents substantial technical and strategic challenges. We present a case treated with mechanical thrombectomy followed by acute extracranial carotid artery stent placement. During treatment of a re-occluded intracranial vessel, the stent retriever became entrapped within the struts of the newly placed carotid stent, resulting in rapid thrombus formation. We describe our approach to managing this complication when efforts to disentangle the devices were unsuccessful. This "Stentriever Sandwich" technique involves secondary angioplasty to peripherally "crush" the stent retriever, opening a central luminal channel enabling deployment of a second carotid stent, resulting in permanent implantation of the stent retriever with preserved antegrade blood flow. Postprocedural management is also discussed. This video article offers a structured approach to navigating the potentially catastrophic complication of stroke intervention.