Double Solitaire™ for ACA and MCA stroke

Patient situation

• Female. 90 years old
• Right hemispheric syndrome NIHSS 19
• Onset 6:00a.m. CT at 7 a.m. from primary stroke center
• rTPA started and the patient was transferred to thrombectomy
• ASPECTS 10
• Right ACA A3 an MCA M2 occlusion at ACT
• HBP, DL, DM2

Set up

• General anesthesia
• Right femoral artery puncture ( 9-French short sheath)
• Flow gate
• Headway 21
• Excelsior sl-10
• 0,014 Traxcess x 2
• Solitaire™ 4 x 40 mm for RMCA
• Solitaire™ 3 x 20 for ACA

Treatment chosen

• The treatment chosen was the use of balloon guide catheter( BGC) and double stent retriever
• BGC was navigated to proximal ICA, proximal to a cervical loop
• Headway was navigated distal to M2 occlusion and a Solitaire™ 4 x 40 mm was deployed
• Excelsior sl-10 was navigated through A3 occlusion and a Solitaire™ 3 x 20 mm was deployed
• Anchoring effect of both Solitaire™ was used to straighten the cervical carotid artery and get up the BGC to proximal petrous segment
• Simultaneous retrieval was performed under continuous aspiration

 

 

 

 

Outcome

• NIHSS 2 24 h
• NIHSS 1 48 h
• mRS1 7 days

Supported by Medtronic