Y-Configuration Dual Stent Retriever Thrombectomy for Bifurcation Occlusions in Acute Ischemic Stroke.

Background

Bifurcation occlusions present unique technical challenges during mechanical thrombectomy. We evaluated the angiographic, clinical, and safety outcomes of Y-configuration dual stent retriever thrombectomy in patients with acute ischemic stroke caused by bifurcation occlusions.

Methods

We retrospectively analyzed 32 consecutive patients treated with Y-configuration dual stent retriever thrombectomy between April 2018 and January 2025. The technique was used as a rescue strategy after failed single-device attempts or as a first-line approach in selected bifurcation occlusions. Angiographic outcomes, procedural metrics, complications, and 90-day clinical outcomes were assessed.

Results

The middle cerebral artery was the most common occlusion site (81.3%). Successful reperfusion (TICI ≥2b) was achieved in 97% of patients, with complete reperfusion (TICI 3) in 91% of cases. Following the first Y-configuration thrombectomy attempt, successful reperfusion (TICI ≥2b) was achieved in 87% of cases, irrespective of prior thrombectomy attempts. Median NIHSS improved from 16 at baseline to 7 at 24 hours. At 90 days, 53% of patients achieved functional independence (mRS ≤2). Symptomatic intracranial hemorrhage occurred in 6.3%; any intracranial hemorrhage occurred in 9.4%, and no vasospasm, vessel dissection, device-related perforation, or subarachnoid hemorrhage was observed.

Conclusions

Y-configuration dual stent retriever thrombectomy appears feasible as a rescue option for selected complex bifurcation occlusions refractory to conventional thrombectomy. Prospective comparative studies are needed to further establish its safety, efficacy, and optimal indications.