Distal Mechanical Thrombectomy with the Solitaire FR Stent in Acute Ischaemic Stroke

Stent-retriever devices achieve high rates of recanalisation in acute ischaemic stroke with proximal arterial occlusion. In the setting of distal occlusion such as M2 middle cerebral artery occlusion, stentretrievers seem safe and recanalisation may double the chances of achieving a favourable outcome. In posterior circulation, technical feasibility, efficacy and safety of stent-retrievers are poorly documented. A 61-year-old man presented with an ischaemic stroke secondary to acute basilar artery occlusion. Mechanical thrombectomy with the Solitaire device was performed and complete recanalisation of basilar artery was achieved; however, a right P2 posterior cerebral artery occlusion was observed due to clot fragmentation. A complete distal artery recanalisation was achieved rapidly after a second passage of the stent-retriever. MR imaging on day 1 revealed a similar volume ischaemic lesion without haemorrhagic event. This case illustrates the feasibility, efficacy and safety of distal P2 posterior circulation occlusion recanalisation with a stent-retriever.