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Ischemic Stroke
Case series
Balloon anchoring technique for thrombectomy in hostile craniocervical arterial anatomy
  1. Vera Sharashidze1,2,
  2. Raul G Nogueira1,2,
  3. Alhamza R Al-Bayati1,2,
  4. Jonathan A Grossberg3,
  5. Diogo C Haussen1,2
  1. 1 Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2 Marcus Stroke & Neuroscience Center - Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
  3. 3 Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr Diogo C Haussen, Neurology, Neurosurgery and Radiology, Emory University School of Medicine/Marcus Stroke & Neuroscience Center - Grady Memorial Hospital, Atlanta, Atlanta, GA 30322, USA; diogo.haussen{at}emory.edu

Abstract

Background Craniocervical catheter access in large vessel occlusion acute ischemic strokes can be challenging in cases of unfavorable aortic arch/cervical vascular anatomy, leading to lower recanalization rates, increased procedural time and worse clinical outcomes. We aim to demonstrate the feasibility of the balloon-anchoring technique (BAT) that can be attempted before switching to alternative access sites.

Methods Retrospective review of prospectively collected information on 11 patients in which two variants of the BAT (proximal anchoring: balloon guide catheter (BGC) is inflated to provide support for distal access; distal anchoring: compliant balloon is inflated in an intracranial artery to allow advancement of the support system) were utilized to facilitate craniocervical access due to failure of conventional maneuvers.

Results Ten patients had anterior and one patient had posterior circulation large vessel occlusions. Mean age was 81 years and 81% were females. Type 3 arches were found in 82% and a 9 French balloon guide catheter was used in 82%. Proximal anchoring with BGC was used in four cases while distal anchoring was used in seven patients to allow access to the target vessel, avoiding the need to puncture alternative access sites. Successful reperfusion (modified treatment in cerebral ischemia 2b-3) was achieved in all cases and no complications were observed.

Conclusion BAT is safe and feasible. It can be considered as a rescue maneuver in order to avoid switching to a different access during thrombectomy in individuals with unfavorable aortic arch/craniocervical anatomy.

  • artery
  • balloon
  • catheter
  • CT angiography
  • CT perfusion

https://doi.org/10.1136/neurintsurg-2019-015347

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    Footnotes

    • Twitter @Vera Sharashidze

    • Contributors VS: Data acquisition, drafting of the manuscript,critical revision of manuscript. AA: Data acquisition, critical revision of manuscript. JG: Critical revision of manuscript, acquisition of data. RGN: acquisition of data, interpretation of data, critical revision of manuscript. DCH: Study conception, design of the work, acquisition of data, interpretation of data, drafting 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.

    • 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 VS: None. AA: None. JG: None. DCH:Consultant for Stryker and Vesalio; Viz-Ai stock options. RGN: Principal Investigator, Stryker Neurovascular (DAWN trial[no compensation],Trevo-2 trial), Cerenovus/Neuravi (ENDOLOW trial, no compensation); consultant to Stryker Neurovascular; steering committee member, Stryker Neurovascular (no compensation), Medtronic (SWIFT trial, SWIFT Prime trial [no compensation]), Cerenovus/Neuravi (ARISE-2 trial, no compensation); angiographic core lab, Medtronic (STAR trial); executive committee member, Penumbra (no compensation); physician advisory board, Cerenovus/Neuravi, Phenox, Anaconda, Genentech, Biogen, Prolong Pharmaceuticals, Allm Inc. (no compensation), Viz-AI; stock options,Viz-AI.

    • Patient consent for publication Not required.

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