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A novel Railroad Technique serially deploys two aligned stent retrievers to enable en bloc capture and retrieval of embolic thrombi at anatomically distant sites. In a case involving tandem ICA and M1 occlusion with large penumbra and no core, sequential retrieval achieved ICA/M1 recanalization and mTICI 2b reperfusion with rapid clinical recovery.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/the-railroad-technique-a-mechanical-thrombectomy-approach-using-serial-deployment-of-two-stent-retrievers-for-tandem-icam1-embolic-occlusion/434644/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/the-railroad-technique-a-mechanical-thrombectomy-approach-using-serial-deployment-of-two-stent-retrievers-for-tandem-icam1-embolic-occlusion/434644.png","ImageObject",300,407,{"name":92,"@type":93},"Melati","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",17,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What clinical problem does the Railroad Technique target?","Question",{"text":113,"@type":114},"It targets embolic tandem occlusions of the intracranial ICA and the M1 segment of the MCA, where conventional single-device approaches may require multiple passes.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How is the Railroad Technique performed in this report?",{"text":118,"@type":114},"Two stent retrievers are deployed in straight, serial alignment to retrieve both thrombi in an en bloc single pass, followed by additional thrombectomy if needed.",{"name":120,"@type":111,"acceptedAnswer":121},"What were the imaging and outcomes in the presented case?",{"text":122,"@type":114},"Imaging showed tandem embolic occlusion with a large penumbra and no ischemic core; mechanical thrombectomy led to ICA and M1 recanalization and mTICI 2b reperfusion, with rapid patient recovery.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},434644,1790739476,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},962085570644,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Journal of Neuroendovascular Therapy 2025; 19: 2025-0125 DOI: [10.5797/jnet.tn.2025-0125](10.5797/jnet.tn.2025-0125)  \nThe Railroad Technique: A Mechanical Thrombectomy Approach Using Serial Deployment of Two Stent Retrievers for Tandem ICA–M1 Embolic Occlusion  \nYuki Yamamoto, 1 Nobuaki Yamamoto, 1 Ayato Kageyama,2 Izumi Yamaguchi,2 Takeshi Miyamoto,2 Masaaki Korai,2 Kenji Shimada,2 Yasushi Takagi,2 and Yuishin Izumi1  \nObjective: Tandem occlusions in acute ischemic stroke are usually atherothrombotic; however, in rare cases, they may result from simultaneous emboli at both proximal and distal sites. Embolic tandem occlusions pose challenges for endovascular therapy because single-stent retrievers (SRs) or aspiration approaches often require multiple passes. This report describes a novel technique that uses serially aligned SRs for en bloc retrieval.  \nCase Presentation: A 90-year-old woman with atrial fibrillation presented with a National Institutes of Health Stroke Scale (NIHSS) score of 22. Imaging revealed an embolic tandem occlusion of the intracranial internal carotid artery (ICA) and the M1 segment of the middle cerebral artery (MCA), with a large penumbra and no ischemic core. A mechanical thrombectomy was performed. Using a 0.074-inch inner diameter distal access catheter, a microcatheter was guided into the M2 inferior trunk. An SR (4 × 40 mm) was deployed across the M2 trunk from the M1 thrombus, followed by the deployment of another SR (6 × 37 mm) across the ICA thrombus. This “Railroad Technique,” in which 2 SRs are deployed in a straight, serial alignment, enabled simultaneous capture and en bloc retrieval of both thrombi in a single pass, resulting in recanalization of the ICA and M1 . A 2nd pass with an SR and aspiration catheter resulted in modified thrombolysis in cerebral infarction (mTICI) 2b reperfusion. The patient recovered rapidly.  \nConclusion: The Railroad Technique may be a feasible option for embolic tandem occlusions with large thrombus volumes and anatomically distant lesions.  \nKeywords▶ mechanical thrombectomy, tandem occlusion, stent retriever, Railroad Technique  \n Introduction  \nTandem occlusion in the context of mechanical thrombectomy refers to the simultaneous or sequential obstruction of 2 or more arterial segments within the same vascular  \n1Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan  \n2Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan  \nReceived: October 4, 2025; Accepted: December 9, 2025  \nCorresponding author: Yuki Yamamoto. Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, Tokushima 770-0035, Japan [Email: yuki.yamamoto412@gmail.com](Email: yuki.yamamoto412@gmail.com)  \nThis work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.  \n©2025 The Japanese Society for Neuroendovascular Therapy  \nterritory. These occlusions are typically atherothrombotic and often result from plaque rupture or arterial dissection in the cervical internal carotid artery (ICA) with subsequent distal embolization. 1,2) However, in rare instances, tandem occlusions may result from embolic sources such as atrial fibrillation, in which both the proximal and distal sites are occluded by discrete emboli.3–5)  \nEmbolic tandem occlusions tend to present with a high clot burden and pose significant challenges in endovascular management. The anatomical separation of occlusion sites complicates device delivery and retrieval strategies. Standard thrombectomy techniques using a single-stent retriever (SR) or aspiration catheter may be insufficient to effectively address both thrombi in a single pass, and multiple passes may increase the risk of distal embolization or procedural complications. We report a rare case of embolic tandem occlusion of the intracranial ICA and the M1 s","cbCaigM5ZhZEyipr","https://ap.wps.com/l/cbCaigM5ZhZEyipr","pdf",2827769,"English","# Objective\n# Case Presentation\n## Imaging and diagnosis\n## Procedure and Railroad Technique\n# Conclusion\n# Keywords","[{\"question\":\"What clinical problem does the Railroad Technique target?\",\"answer\":\"It targets embolic tandem occlusions of the intracranial ICA and the M1 segment of the MCA, where conventional single-device approaches may require multiple passes.\"},{\"question\":\"How is the Railroad Technique performed in this report?\",\"answer\":\"Two stent retrievers are deployed in straight, serial alignment to retrieve both thrombi in an en bloc single pass, followed by additional thrombectomy if needed.\"},{\"question\":\"What were the imaging and outcomes in the presented case?\",\"answer\":\"Imaging showed tandem embolic occlusion with a large penumbra and no ischemic core; mechanical thrombectomy led to ICA and M1 recanalization and mTICI 2b reperfusion, with rapid patient recovery.\"}]","The Railroad Technique - A Mechanical Thrombectomy Approach Using Serial Deployment of Two Stent Retrievers for Tandem ICA–M1 Embolic Occlusion | PDF",1790670113,18]