Microsurgical Removal of Snagged Stent Retriever During Endovascular Embolectomy for Acute Ischemic Stroke.

Abstract

Catheter-based endovascular thrombectomy has gained popularity for use in patients with acute large-vessel occlusion; however, various complications have been reported. Herein, we present a unique, serious procedure-related complication. A 91-year-old woman with acute middle cerebral artery (MCA) occlusion underwent endovascular thrombectomy with a stent retriever, but the device could not be retrieved from the horizontal segment of MCA during the procedure. Subsequently, she underwent emergency craniotomy. The lodged stent was extracted with microforceps using a counter-stretch of the vessels, so as not to avulse the perforating arteries. The stent device was retrieved uneventfully through a sheath introducer that was inserted through the femoral artery. Postprocedural indocyanine green video angiography showed complete recanalization of the MCA and internal cerebral artery. This is a rare case in which successful open surgery was performed to retrieve a snagged stent retriever, with successful recanalization of the large cerebral artery occlusion.