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Original research
Relay-balloon technique for recanalization of acute symptomatic proximal internal carotid artery occlusion with short balloon-tipped guiding catheter landing zone
  1. Sang Hun Lee1,
  2. Dong Geun Lee2,
  3. Sun U Kwon3,
  4. Deok Hee Lee1
  1. 1Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
  2. 2Department of Neurology, Sejong General Hospital, Bucheon, Gyeonggi-do, Republic of Korea
  3. 3Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
  1. Correspondence to Dr Deok Hee Lee, Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, Republic of Korea; dhlee{at}


Background Endovascular recanalization of a completely occluded proximal internal carotid artery (ICA) with underlying stenosis may be challenging owing to a possible thrombotic component. This is especially true when the landing zone for a balloon-tipped guiding catheter (BGC) at the bulb portion is insufficient. Sequential application of the balloons of a BGC and an angioplasty catheter may prevent thromboembolism during revascularization. This study analyzed the safety and effectiveness of this relay-balloon technique.

Methods Ten consecutive patients with acute symptomatic proximal ICA occlusion were treated by the relay-balloon technique. Outcomes analyzed included technical success rate, procedure-related complications, and short-term clinical outcomes.

Results Successful revascularization was achieved in all 10 patients. One patient experienced a post-procedural infarct extension, but there was no change in National Institutes of Health Stroke Scale (NIHSS) score. Mean NIHSS score decreased from 12.0±5.6 (range 0–18) initially to 6.8±5.4 (range 0–18) at discharge.

Conclusions The relay-balloon technique is safe and effective in the endovascular revascularization of acute symptomatic proximal ICA occlusions, which are at high risk of distal thromboembolism due to insufficient landing zone for the BGC.

  • Intervention
  • Stroke
  • Technique
  • Thrombectomy
  • Thrombolysis

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  • Contributors SHL contributed to the study conception and design, data analysis, acquisition of clinical and imaging data, statistical analysis, manuscript drafting and revision. DGL contributed to the study conception and design, data analysis and manuscript drafting. SUK contributed to the conception of the study and data analysis. DHL contributed to the study conception and design, analysis and interpretation of the imaging and clinical data, manuscript drafting and revision, and study supervision.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethical approval was obtained from the Asan Medical Center Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.