Stenting of mobile calcified emboli after failed thrombectomy in acute ischemic stroke: case report and literature review

Abstract Background Mobile calcified emboli are a rare cause of large vessel occlusion and acute ischemic stroke and pose unique challenges to standard mechanical thrombectomy techniques. Intracranial stenting has been reported as a rescue maneuver in cases of failed mechanical thrombectomy due to dissection or calcified atherosclerotic plaques, but its use for calcified emboli is not well-described. Case description Here we present two cases of acute ischemic stroke caused by mobile calcified emboli. Standard mechanical thrombectomy techniques using aspiration catheters and stent-retrievers failed to remove these emboli so intracranial stenting was successfully performed in each case, albeit after overcoming unique challenges associated with the stenting of calcified emboli. Conclusion Mobile calcified emboli are rare causes of acute ischemic stroke. Intracranial stenting can be used to successfully treat calcified emboli when mechanical thrombectomy has failed. We also review the literature on intracranial stenting as a salvage therapy for failed mechanical thrombectomy.