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

Intravenous (IV) administration of recombinant tissue plasminogen activator (rtPA) within 3 hours of symptom onset in patients with acute ischemic stroke has been proven to be an effective treatment. However, IV rtPA alone is occasionally insufficient to treat severe neurological deficit due to persistent major vascular occlusion. Since early recanalization is directly correlated with functional recovery and the rate of recanalization of major arterial occlusion with IV rtPA is low, an additional neuroendovascular approach would be a reasonable alternative for patients unresponsive to IV rtPA. In our hospital, three-dimensional computed tomography (CT) angiography is obtained before or during IV rtPA. For patients with major arterial occlusion who show no remarkable improvement of the neurological deficits after IV rtPA, we aggressively perform addit ional neuroendovascular treatment. Soutenir (Solution, Yokohama) is a basket-shaped microsnare which can be used to retrieve a thrombus (Fig. 1). Here, we report two cases of acute ischemic stroke patients who were unresponsive to rtPA and were successfully treated by thrombectomy using Soutenir.