The use of balloon guide catheters in acute ischemic stroke intervention has been associated with improved reperfusion rates and clinical outcomes. This technique acts by promoting flow arrest and subsequent reversal to capture the thrombus debris that may be generated during the clot retrieval process. However, to the best of our knowledge, the use of BGC to remotely aspirate and remove intracranial thrombus has not been previously described. We report a three case series of patients with acute ischemic stroke from supraclinoidal internal carotid artery occlusions treated with remote aspiration thrombectomy through a BGC placed at the cervical internal carotid artery, leading to complete reperfusion without the need for intracranial catheterization. Remote thrombectomy in the setting of intracranial internal carotid artery occlusion may constitute a relatively fast and inexpensive initial thrombectomy maneuver. Further investigation is warranted.
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Contributors DCH: study conception, acquisition of the data, and drafting of the manuscript. MB: data acquisition and critical revision of the manuscript. JAG: interpretation of the data and critical revision of the manuscript. RGN: study conception and critical revision of the manuscript. All authors gave final approval of the version to be published, and are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Competing interests RGN: Stryker (PI: Trevo-2 PI/DAWN Trials), Covidien (SWIFT/SWIFT-PRIME Steering Committee, STAR Trial Core-Lab), and Penumbra (3-D Trial Executive Committee).
Ethics approval The study was approved by the local institutional review board.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Unpublished data from this dataset are held by Grady Memorial Hospital/Emory University and DCH/RGN. Requests for data sharing would be required to be discussed with them directly.
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