Benchtop evaluation of a double stent retriever thrombectomy technique for acute ischemic stroke treatment

Background A mechanical thrombectomy technique using a double stent retriever (DSR) approach has been reported for the treatment of patients with acute ischemic stroke. The purpose of this study was to perform a benchtop evaluation of the mechanism of action and efficacy of a DSR approach compared to a single stent retriever approach. Methods In vitro mechanical thrombectomy procedures were performed in a vascular phantom reproducing a M1-M2 occlusion with two different clot analog consistencies (soft and hard). We compared the DSR approach to the single stent retriever approach and recorded the recanalisation rate, distal embolization, and retrieval forces of each mechanical thrombectomy procedure. Results The DSR approach achieved a higher recanalization rate and lower embolic complications compared to the single stent retriever approach. This seems to stem from two facts: the greater probability of targeting the correct artery with two stents in the case of bifurcation occlusion, and an improved clot capture mechanism using the DSR approach. However, the DSR was associated with an increased initial retrieval force. Conclusions In vitro evaluation of the mechanism of action of the DSR provided explanations that appear to support the high efficacy of such an approach in patient cohorts and could help operators when selecting the optimal mechanical thrombectomy strategy in cases of arterial occlusions difficult to treat with a single stent retriever.