title: Double solitaire mechanical thrombectomy in acute stroke: effective rescue strategy for refractory artery occlusions?
abstract: OBJECTIVE
  Mechanical thrombectomy by using a single stent retriever system has demonstrated high efficacy for recanalization of large-artery occlusions in acute stroke. We aimed to evaluate the feasibility, safety, and efficacy of a novel double Solitaire stent retriever technique as an escalating treatment for occlusions that are refractory to first-line single stent retriever mechanical thrombectomy.
  
  
  METHODS
  All patients treated with the double stent retriever technique by using the Solitaire system were retrospectively selected from 2 large neurointerventional centers. Time to recanalization, angiographic (TICI) and clinical outcomes (mRS), and complications were assessed.
  
  
  RESULTS
  Ten patients (median NIHSS score, 16; mean age, 70 years) with MCA M1 segment (n = 5) and terminal ICA (n = 5 including 2 ICA tandem) occlusions were included. Prior single stent retriever mechanical thrombectomy had been performed in 9 patients (median number of passes, 3). Median time to recanalization was 60 minutes (interquartile range, 45-87 minutes). Procedure-related complications occurred in 1 patient; overall mortality was 20%. Recanalization of the target vessel (TICI 2b/3) was achieved in 80%. Good clinical outcome (mRS 0-2) was 50%.
  
  
  CONCLUSIONS
  In this preliminary feasibility study, the double Solitaire stent retriever technique proved to be an effective method for recanalization of anterior circulation large-artery occlusions refractory to standard stent retriever mechanical thrombectomy.
authors.affiliation: From the Institute of Diagnostic und Interventional Radiology and Neuroradiology (J.K., V.S., C.S.), Helios Klinikum, Erfurt, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Klisch
authors.affiliation: From the Institute of Diagnostic und Interventional Radiology and Neuroradiology (J.K., V.S., C.S.), Helios Klinikum, Erfurt, Germany.
authors.forename: V
authors.initials: V
authors.lastname: Sychra
authors.affiliation: From the Institute of Diagnostic und Interventional Radiology and Neuroradiology (J.K., V.S., C.S.), Helios Klinikum, Erfurt, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Strasilla
authors.affiliation: Departments of Neuroradiology (C.A.T., H.U., S.M.).
authors.forename: C A
authors.initials: CA
authors.lastname: Taschner
authors.affiliation: Neurology (M.R.), University Hospital Freiburg, Freiburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Reinhard
authors.affiliation: Departments of Neuroradiology (C.A.T., H.U., S.M.).
authors.forename: H
authors.initials: H
authors.lastname: Urbach
authors.affiliation: Departments of Neuroradiology (C.A.T., H.U., S.M.) stephanmeckel@gmail.com.
authors.forename: S
authors.identifier: http://orcid.org/0000-0001-6468-4526
authors.initials: S
authors.lastname: Meckel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000209:etiology / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome