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KMID : 1150320230190020024
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Journal of Korean Society of Geriatric Neurosurgery
2023 Volume.19 No. 2 p.24 ~ p.30
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Safety and effectiveness of the modified stent retrieval technique in elderly patients with secondary distal vessel occlusion
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Shin Jeong-Eun
Jeon Hong-Jun
Gisela Bretzel
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Abstract
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Objective : This study aimed to investigate the efficacy and safety of the modified stent retrieval (STR) technique in solving the problem of newly migrated embolic particles during primary mechanical thrombectomy for acute large vessel occlusion (LVO), specifically in patients aged 65 and older. In order to minimize risk and enhance the success rate, a modified STR technique was developed, which enables control over the unsheathing level of the microcatheter. We investigated the safety and effectiveness of this technique in resolving distal vessel occlusion (DVO) resulting from migrated emboli in elderly patients.
Methods : Between January 2016 and February 2022, 16 patients (5.4% of 294 total patients) aged 65 and older, who presented with an acute LVO stroke in the anterior circulation and secondary migration of the embolus into M2, M3, A2, or A3 branches, underwent the modified STR technique.
Results : After recanalizing the primary LVO, secondary DVO occurred in 7/4/4/1 patients in M2/M3/A2/A3, respectively. The modified Thrombolysis in Cerebral Infarction (mTICI) score was 2a in 5 patients and 2b in 11 patients for LVO. The one-pass rate was 62.5% and the final recanalization rate of at least TICI 2c at the migrated DVO was 15 out of 16 patients (93.8%, mean duration, 25.2±13 minutes) without significant complications. A favorable functional outcome (modified Rankin Scale, 0-2) was achieved in 8 (50.0%) patients at 3 months.
Conclusion : The modified STR technique is simple and can improve the safety and effectiveness of recanalization in DVO caused by migrated emboli in elderly patients.
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KEYWORD
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Arterial occlusive diseases, Thrombectomy, Stents
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