title: Utility of a Y-configured stentriever technique as a rescue method of thrombectomy for an intractable rooted thrombus located on the middle cerebral artery bifurcation: technical note.
abstract: Mechanical thrombectomy with stentriever and/or aspiration is the new gold standard for the treatment of acute strokes with large-vessel occlusion. As many as 20% of cases remain refractory to current stentriever and/or aspiration devices. "Saddle clots" obstructing a bifurcation may be a particular challenge for recanalization with conventional techniques and devices. The authors describe an alternative technique to bifurcation occlusions resistant to the conventional mechanical thrombectomy approach in which they simultaneously deployed 2 stentrievers into both branches of an occluded bifurcation. This stentriever Y-configuration was very effective in managing a challenging intracranial bifurcation occlusion.
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois.|Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama City, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Okada
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois.|Department of Neurosurgery, Wakayama Medical University, Wakayama City, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Matsuda
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois.|Department of Neurosurgery, Gangnam Severance Hospital, and.|Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Republic of Korea; and.
authors.forename: Joonho
authors.initials: J
authors.lastname: Chung
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois.
authors.forename: R Webster
authors.initials: RW
authors.lastname: Crowley
authors.affiliation: Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois.
authors.forename: Demetrius K
authors.initials: DK
authors.lastname: Lopes
mesh_terms: D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D015607:Stents; D017131:Thrombectomy / Q000295:instrumentation* / Q000379:methods*; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*
keywords: ICA = internal carotid artery; MCA = middle cerebral artery; MT = mechanical thrombectomy; TICI = Thrombolysis in Cerebral Infarction; emergency large-vessel occlusion; mechanical thrombectomy; penumbra; rooted thrombus; stentriever; tPA = tissue plasminogen activator