Effectiveness of Retrograde Angiography via the Contralateral Carotid Artery in Mechanical Thrombectomy for Carotid Non-T Occlusion by Dual Puncture Technique

OBJECTIVE: We report the effectiveness of retrograde angiography via the contralateral carotid angiography using a dual puncture technique in mechanical thrombectomy (MT) for non-T occlusion in patients with acute internal carotid artery (ICA) occlusion not involving the ICA terminus. CASE PRESENTATION: In the dual puncture technique, arterial puncture is performed at two sites: a balloon guiding catheter (BGC) is navigated to the ICA on the affected side and another catheter is navigated to the unaffected side. Thrombus retrieval is performed by manual aspiration through the BGC and MT using a stent retriever and/or aspiration device. Reperfusion is confirmed by retrograde angiography via the carotid artery on the unaffected side, with manual aspiration through the BGC on the affected side. Throughout the procedure, the BGC blocks the blood flow in the ICA on the affected side until reperfusion is confirmed. No distal embolization was occurred in our three patients treated using this technique. CONCLUSION: Application of the dual puncture technique on MT is recommended for non-T occlusion to prevent distal embolization.