Magnetic Resonance Imaging-guided Double Stent Retriever Thrombectomy for Bifurcation Occlusions and Long Thrombi

Background and Purpose To evaluate the role of the double stent retriever (SR) technique in mechanical thrombectomy (MT) for acute ischemic stroke with bifurcation occlusions and long thrombi on magnetic resonance imaging (MRI). Methods The retrospective observational study was conducted between February 2023 and September 2024 on acute ischemic stroke patients with anterior circulation large vessel occlusion who underwent MT with multiple SRs. Technical success was defined as successful recanalization (mTICI ≥ 2b) without additional techniques. The primary efficacy outcome was an independent functional status (modified Rankin score 0-2) at 90 days. Results Sixteen patients (median age [IQR], 58.5 [47.5-67] years; males, 12/16 [75%]) underwent MT with the double SR technique. SRs were deployed into both middle cerebral artery (MCA) divisions (8/16, 50%), anterior cerebral artery and MCA (3/16, 18.8%), one division of MCA in parallel (2/16, 12.5%), M1 and M2 segments of the MCA in series (1/16, 6.3%), or internal carotid artery (ICA) and MCA in series (1/16, 6.3%). In one case, three SRs were deployed in series in the ICA and MCA. The first pass recanalization rate with the double SR technique was 60% (6/10). The technical success rate was 62.5% (10/16), and the final recanalization rate was 81.3% (13/16). Eight patients (50%) had independent functional status at 90 days, while two (12.5%) had symptomatic intracranial hemorrhage. Conclusion The double SR technique has a moderately high recanalization rate in patients with acute ischemic stroke when the thrombus is long or involves the ICA or MCA bifurcation on MRI.