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

Hong Suk Ahn, Jung Hyun Park, Jun Hyong Ahn, Hong Jun Jeon, Byung Moon Cho

This study evaluated the safety and effectiveness of a modified stent retrieval technique controlling the micro catheter’s unsheathing level to resolve distal vessel occlusions from migrated emboli. From January 2016 to February 2022, this technique was used on 24 of 445 patients with acute large vessel occlusion strokes in the anterior circulation, with secondary embolus migration into M2, M3, A2, or A3 branches. The procedure used radiopaque stent retrieval systems like Trevo XP 4 ×20 mm and Solitaire Platinum 4 × 20 mm, adjusting coverage through partial re-sheathing of the microcatheter. After recanalizing the primary occlusion, secondary occlusion occurred in 12/6/4/2 patients in the M2/M3/A2/A3 branches, respectively (time from puncture to primary recanalization: 45.5 ± 17 min). Modified TICI scores were 2a and 2b in 8 and 16 patients, respectively. The one-pass rate for secondary occlusions was 70.8%, and 23 of 24 patients achieved a final recanalization rate of at least TICI 2c at the migrated occlusion (mean duration: 23.2 ± 14 min) without significant complications. At 3 months, 16 patients achieved favorable outcomes (mRS, 0–2). This technique was simple, safe, and effective in resolving distal occlusions from migrated emboli.