Stent retriever angioplasty with the Tigertriever as a bailout strategy for intracranial atherosclerotic disease-related large-vessel occlusion: illustrative cases.

backgroundIntracranial atherosclerotic disease-related large-vessel occlusion (ICAD-LVO) is associated with residual stenosis and early reocclusion following mechanical thrombectomy (MT), particularly in Asian populations. Conventional stent retrievers (SRs) are optimized for embolus removal and may not provide sufficient mechanical dilation. The Tigertriever is a radially adjustable SR with operator-controlled expansion and manual constriction, enabling stentoplasty and safe retrieval. OBSERVATIONS: This study retrospectively analyzed the data of 3 consecutive patients with ICAD-LVO who were treated using a sequential algorithm that included initial conventional MT, followed by Tigertriever-assisted stentoplasty and loading doses of DAPT. Durable recanalization was performed in 2 cases involving the middle cerebral artery and internal carotid artery, respectively, with 1 patient showing significant functional improvement, from a modified Rankin Scale score of 5 to 1 on day 7. The third case involved the vertebral artery and showed temporary recanalization despite eventual recurrent occlusion, with neurological preservation reflecting collateral adaptation. LESSONS: Tigertriever-assisted stentoplasty combined with DAPT is a promising sequential bridge strategy for refractory ICAD-LVO identified during thrombectomy. By achieving direct mechanical vessel dilation similar to balloon angioplasty while simultaneously maintaining antegrade flow, the Tigertriever provides a physiological bridge during which loading doses of DAPT can reach effective platelet inhibition. https://thejns.org/doi/10.3171/CASE26605.