Rescue permanent LVIS stenting with post-stenting angioplasty after failed mechanical thrombectomy for refractory internal carotid artery occlusion at the paraclinoid segment: two-case report

BACKGROUND: Previous studies indicated the effectiveness of permanent stenting when dealing with retriever-failed refractory large vascular occlusion (LVO). Variety types of stents were implanted permanently to achieve recanalization. Low-profile visualized intraluminal support (LVIS) is generally used as a supportive device for embolization of intracranial aneurysm. Its specific structural and functional characteristics contribute to its potential of treating LVO. CASES PRESENTATION: A 51-year-old male was transferred to our stroke center because of conscious disturbance with the weakness of the left upper limb. The National Institute of Health Stroke Scale (NIHSS) was 24; the Glasgow Coma Scale (GCS) was 10. Digital subtraction angiography (DSA) showed that his paraclinoid segment of R-ICA was occluded due to hard clot embolization. Thrombectomy was performed 6 times, but the occlusion remained. Finally, LVIS was implanted permanently and post-dilation was performed, which successfully recanalized the artery (eTICI 2c). The post-operative NIHSS and GCS were 20 and 11, respectively, which were 10 and 14 when discharged. Another patient was a 71-year-old male who suffered weakness of left limbs. NIHSS was 15; GCS was 11. DSA confirmed that the paraclinoid segment of his R-ICA was occluded due to hard clot embolization. Totally 6 times of mechanical thrombectomy, angioplasty, and tirofiban infusion were performed, which failed to recanalize the artery. In the end, LVIS implantation with post-dilation was performed, and full recanalization was achieved (mTICI 3). The post-operative NIHSS and GCS were 9 and 15, respectively, which were 3 and 15 when discharged. CONCLUSIONS: These 2 cases invited LVIS into the treatment of refractory occlusion due to hard clot embolization at the paraclinoid segment, and the outcomes were preferable because of the higher visibility, higher flexibility, and lower cell size of LVIS.