Stroke thrombectomy of a mural thrombus in a severe dolichoectatic basilar artery with double parallel large stent retrievers and Sofia 88.
Julian Michael Burwell, Tyler M Bielinski, Philipp Hendrix
✦ AI-curated · Sources linked
Case in brief
An older adult presented with severe acute ischemic stroke from a mural thrombus on the posterior wall of the mid-basilar artery. The artery was markedly dolichoectatic, with a diameter greater than 10 mm, length greater than 40 mm, and suprasellar extension greater than 15 mm. After intravenous tenecteplase, thrombectomy with a single 6.5 mm stent retriever and Sofia 88 aspiration did not achieve sufficient recanalization. A salvage attempt using 6.5 mm and 6 mm stent retrievers in parallel with aspiration achieved complete recanalization and TICI 3 reperfusion, followed by rapid clinical recovery.
What made this case unusual
The markedly enlarged, tortuous basilar artery limited the initial single-device thrombectomy. Parallel deployment of two large stent retrievers with concomitant aspiration was used as a salvage strategy and achieved complete reperfusion.
Diagnostic / clinical pearl
In severe basilar dolichoectasia, vessel caliber and tortuosity can limit conventional thrombectomy; this case describes successful salvage with parallel large stent retrievers and aspiration after an insufficient initial attempt.