Resolving Distal Vessel Occlusions Caused by Migrated Emboli: Outcomes of Modified Stent Retrieval Technique

Abstract

Abstract This study aimed to retrospectively evaluate the safety and effectiveness of a modified stent retrieval technique that controls the unsheathing level of the microcatheter in resolving distal vessel occlusions caused by migrated emboli. From January 2016 to February 2022, the modified stent retrieval technique was applied to 24 of 445 patients with acute large vessel occlusion strokes in the anterior circulation, featuring secondary embolus migration into M2, M3, A2, or A3 branches. The procedure included radiopaque stent retrieval systems, including Trevo XP 4 x 20 mm and Solitaire Platinum 4 x 20 mm. Coverage range was adjusted through partial re-sheathing of the delivery microcatheter after full unsheathing. After recanalizing the primary large vessel occlusion, secondary distal vessel occlusion occurred in 12/6/4/2 patients in the M2/M3/A2/A3 branches, respectively (time from puncture to primary large vessel occlusion recanalization: 45.5 ± 17 min). The modified TICI score was 2a and 2b in 8 and 16 patients, respectively, for primary large vessel occlusion. The one-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 achieved favorable functional outcome (mRS, 0–2). Thus, this modified technique was simple and effective, demonstrating both safety and efficacy in resolving distal vessel occlusion caused by migrated emboli.