Double Stent Retriever Technique for Mechanical Thrombectomy: A Systematic Review and Meta-Analysis

Illustration of the parallel and stent-in-stent DSR techniques. A, Navigation of the first microcatheter over a microwire distal to the clot (step common to both DSR techniques), as in conventional thrombectomy using an SSR. Deployment of the stent retrievers (3 different steps between the parallel and stent-in-stent DSR techniques). B, In the parallel DSR technique, B1, A second microcatheter is navigated distal to the clot on a microwire, ideally in an arterial branch different from the first microcatheter. B2, The first SR is deployed distally and through the clot. As with the MT SSR, the clot should be in the proximal part of the SR. B3, The second SR is deployed, ideally with the clot also in the proximal part of the SR. C, In the stent-in-stent technique, C1, The first SR is deployed distally and through the clot, ideally with a clot in the proximal part of the SR. C2, A second microcatheter is navigated distal to the clot over a microwire through the mesh of the first stent, ideally into an arterial branch different from the one used for the first microcatheter. C3, The second SR is deployed, ideally with the clot also in the proximal part of the SR. D, Removal of the 2 SRs together (common to both DSR techniques). Both SRs are removed at the same time and at the same slow speed. To ensure that the removal of both SRs begins at the same time, it is important to tension both stents before retrieval. It may also be useful to place a single torque on the pushwires of both stents once they have been tensioned, to remove the stents at an identical and harmonious speed.