Image-based visualization of stents in mechanical thrombectomy for acute ischemic stroke: Preliminary findings from a series of cases

Figure 1 Operative procedure: Patient 1. A: Digital subtraction angiography (DSA) revealing proximal basilar artery (BA) occlusion (arrow); B: Stent deployed at the left posterior cerebral artery (LPCA)-P1 segment and BA (without stent imaging, arrow); C: DSA revealing the upper part of the BA occlusion (arrow); D: Stent deployed in the proximal region of the right posterior cerebral artery (RPCA)-P1 segment to capture the thrombus; E: DSA revealing the RPCA and LPCA-P1 segment proximal occlusion (arrow); F: Stent placed in the distal LPCA-P1 segment (without stent imaging, arrow); it was unable to capture a thrombus; G: Stent deployed at the LPCA-P2 segment and stent imaging presenting a grid-form shadow; H: Stent capturing three fragmented thrombi; I: Repeat DSA revealing good recanalization.

Figure 2 Operative procedure: Patient 2. A: Digital subtraction angiography (DSA) revealing left middle cerebral artery (LMCA)-M1 segment occlusion (arrow); B: DSA revealing good recanalization of the M2 segment upper (arrow) and lower branch occlusions; C: The stent was deployed and retrieved without stent imaging (arrow); D: Angiogram revealing no recanalization postoperatively (arrow); E: The stent was redeployed at the distal M2 segment with a partial development of stent imaging; F: DSA after stent deployment revealing good recanalization of the LMCA-M2 segment (arrow).

Figure 3 Operative procedure: Patient 3. A: Digital subtraction angiography (DSA) revealing distal right internal carotid artery-C7 segment occlusion with poor collateral circulation (arrow); B: Stent deployed and retrieved at the proximal right middle cerebral artery (RMCA)-M1 segment without stent imaging (arrow); C: After removing a thrombus, the DSA showed that the RMCA-M2 segment upper branch remained occluded (arrow); D: Stent-based mechanical thrombectomy can be observed (arrow); E: Local enlarged stent imaging showing strip-shaped distribution (arrow); F: Repeat DSA revealing good recanalization of the RMCA.

Figure 4 Operative procedure: Patient 4. A: Digital subtraction angiography revealing left distal internal carotid artery (ICA) occlusion with poor blood flow compensation (arrow); B: Solitaire AB (6 mm × 30 mm) stent was deployed at the distal left middle cerebral artery-M1 segment (arrow); C: Stent imaging can be observed (arrow); D: Second (repeat) angiogram revealing good recanalization of the left ICA after the removal of the thrombi (arrow).