Stroke thrombectomy of a mural thrombus in a severe dolichoectatic basilar artery with double parallel large stent retrievers and Sofia 88.

Abstract

Dolichoectasia of the basilar artery poses significant challenges for endovascular therapy due to extreme vessel caliber and tortuosity, limiting the efficacy of conventional thrombectomy devices. We present the case of an older adult with severe acute ischemic stroke caused by a mid-basilar posterior wall mural thrombus within a markedly dolichoectatic basilar artery (diameter >10 mm, length >40 mm, suprasellar extension >15 mm).1-3 Following intravenous tenecteplase, mechanical thrombectomy was attempted using a single 6.5 mm stent retriever with aspiration via a Sofia 88 catheter, but failed to achieve sufficient recanalization. As a salvage strategy, two large stent retrievers (6.5 mm and 6 mm) were deployed in parallel, and mechanical thrombectomy was performed with concomitant aspiration (video 1).4 This approach achieved complete basilar artery recanalization and reperfusion (Thrombolysis In Cerebral Infarction (TICI) 3). The patient demonstrated rapid clinical recovery. This case highlights a practical salvage technique for thrombus removal in severe basilar dolichoectasia, emphasizing the need for tailored thrombectomy strategies in nonstandard vascular anatomies.neurintsurg;jnis-2025-023562v1/V1F1V1Video 1 .