Thrombectomy with Soutenir for acute ischemic stroke patients unresponsive to intravenous recombinant tissue plasminogen activator

●Abstract● Purpose: We report two cases of acute ischemic stroke patients treated by additional thrombectomy using a basket-shaped microsnare (Soutenir) after infusion of intravenous recombinant tissue plasminogen activator (rtPA). Successful recanalization and good prognosis were achieved in both cases. Case 1: A 67-year-old man presented with left hemiplegia and agnosia. After completion of the intravenous rtPA infusion, he continued to show severe neurological deficit. Angiography revealed occlusion of the posterior trunk and a branch of the anterior trunk of the right middle cerebral artery (MCA). The two occluded arteries were successfully recanalized by removing the clot with Soutenir, resulting in neurological improvement. Case 2: A 49-year-old man presented with right hemiplegia and aphasia. After completion of the intravenous rtPA infusion, he continued to show severe neurological deficit. Angiography revealed occlusion of the left MCA at the proximal M1 segment. The occluded artery was successfully recanalized by removing the clot in the manner described above, resulting in neurological improvement. Conclusion: To our knowledge, this is the first report describing patients treated by additional thrombectomy using a Soutenir after failed intravenous infusion of rtPA. This procedure is a therapeutic option for selected acute ischemic stroke patients who are unresponsive to intravenous rtPA.