The application of mechanical thrombectomy technology has significantly improved the recanalization rate and clinical prognosis of patients with large vessel occlusion (LVO). However, in actual operation, due to the complex thrombus morphology, special location or abnormal vascular anatomical structure, the conventional single-stent thrombectomy technology combined with aspiration technology may not be able to achieve complete recanalization in some patients. These cases often show large thrombus load and high hardness, or the thrombus is located at the bifurcation site, such as the terminal of the internal carotid artery, the bifurcation of the middle cerebral artery, and the apex of the basilar artery.
It is in this context that the dual-stent thrombectomy technique was developed as an important remedial measure for complex lesions. This technique uses two thrombectomy stents in the thrombus area to form a synergistic effect, increase the coverage area and capture efficiency of the thrombus, and has significant advantages, especially for cases where multiple conventional thrombectomy failures have occurred. The dual-stent thrombectomy technique can effectively deal with hard thrombi, large-load thrombi, and bifurcation thrombi, and is one of the important remedial technologies to improve the recanalization rate.
Double-stent thrombectomy technology includes three main modes: serial or parallel double-stent thrombectomy, Y-type double-stent thrombectomy and X-type double-stent thrombectomy. As shown in the figure below, A is a parallel double-stent thrombectomy, B is a Y-type thrombectomy at the end of the internal carotid artery, and C is a Y-type thrombectomy at the middle cerebral artery. The serial double-stent thrombectomy technology sequentially covers the thrombus area with two stents, which is suitable for long-segment occlusion of large-load thrombi; the Y-type double-stent thrombectomy technology targets bifurcation thrombi and is used for bifurcation occlusion or large-load thrombi. Each technology has its own unique application scenarios and operating characteristics, providing an efficient recanalization solution for stubborn thrombectomy failure.
The technical features of the three main dual-stent thrombectomy technologies are as follows:
1. Series or parallel dual-stent thrombectomy technology.
This technology is to cover the thrombus area with two stents in sequence, thereby increasing the capture area of the thrombus, and is suitable for lesions with large thrombus load and long length. This technology improves the efficiency of thrombus removal by double stents, increasing the stent length of the thrombus, and increasing the radial support force, especially in the case of hard thrombus and heavy load thrombus.
2. Y-type dual-stent thrombectomy technology.
The Y-type dual-stent thrombectomy technology is specially designed for hard thrombus at bifurcation. By placing stents in the bifurcation branches and forming a Y-shaped structure, the capture efficiency of thrombus at the bifurcation site is increased. This technology is particularly effective for bifurcation thrombus, such as LVO caused by hard thrombus at the end of the internal carotid artery and the tip of the basilar artery.
3. X-type dual-stent thrombectomy technology.
The X-type dual-stent thrombectomy technology is used to remove bifurcation thrombus or heavy load thrombus by placing two stents crosswise to form an X-shaped coverage. During stent thrombectomy, due to the difficulty of superselection outside the stent, it may be necessary to superselect another branch through the stent mesh to form an X-shaped coverage, which is suitable for bifurcations and large-load thrombus removal.