Anatomical vessel obstacles such as an intracranial stenosis in stroke are challenging and may lead to delayed clot access for thrombectomy. We describe a simple and effective technique to overcome the step-off between the intermediate catheter and an intracranial vessel stenosis during thrombectomy. The patient presented with acute embolic left middle cerebral artery occlusion and a favorable penumbral pattern. Clot access was made challenging by focal stenosis in the ipsilateral cavernous segment. The balloon-assisted tracking technique was effective in traversing the step-off to enable TICI 3 aspiration thrombectomy. This simple and effective technique should be kept in mind during stroke procedures where a proximal stenotic obstacle complicates access to the site of occlusion.
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Republished with permission from BMJ Case Reports Published 10 December 2018; doi: 10.1136/bcr-2018-014275
Contributors Conception, design of the work: J-KB, MS, PKN. Acquisition, analysis and interpretation of data: J-KB, MS, OT, ML, BC, ER, HAR, PKN. Drafting the work: J-KB, MS. Revising it critically for important intellectual content: J-KB, MS, OT, ML, BC, ER, HAR, PKN. Final approval of the version published: J-KB, MS, OT, ML, BC, ER, HAR, PKN. 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: J-KB, MS, OT, ML, BC, ER, HR, PKN.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Ethics approval NYU Langone Medical Center.
Provenance and peer review Not commissioned; externally peer reviewed.