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Use of Walrus balloon-guide catheter through sheathless radial approach for mechanical thrombectomy of right middle cerebral artery occlusion
  1. Rimal H Dossani1,
  2. Muhammad Waqas2,
  3. Hamid H Rai2,
  4. Andre Monteiro2,
  5. Faisal Almayman2,
  6. Justin M Cappuzzo2,
  7. Jason M Davies3
  1. 1Department of Neurosurgery/Endovascular, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  2. 2Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
  3. 3Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA
  1. Correspondence to Dr Jason M Davies, Department of Neurosurgery, University at Buffalo, Buffalo, USA; jdavies{at}ubns.com

Abstract

The literature demonstrates a favorable first pass effect with balloon-guide catheter (BGC) for mechanical thrombectomy. An 8F BGC is routinely used with femoral access. We present the first video report of 8F BGC advanced through the radial artery using a sheathless technique (video 1). An approximately 70-year-old patient presented with left-sided hemiplegia, neglect, and dysarthria. A CT angiogram demonstrated right M1 occlusion, and the patient underwent urgent mechanical thrombectomy. Radial approach was preferred owing to patient history of anticoagulation. A 6F Sim Select intermediate catheter was used to minimize the step off as the 8F BGC was advanced into the radial artery over an 035 exchange-length Advantage Glidewire. A skin nick over the Glidewire Advantage facilitated the introduction of the 8F BGC into the radial artery. Standard mechanical thrombectomy using a combination of stent retriever and aspiration catheter (Solumbra technique) was performed, and thrombolysis in cerebral infarction 3 recanalization was achieved after a single pass. The National Institutes of Health Scale score improved from 12 to 4, with mild left facial droop, dysarthria, and decreased speech fluency. The patient was discharged from the hospital on postoperative day 2. Ultrasound should be used for immediate assessment of radial artery size and conversion to femoral access without delay if the radial artery is less than 2.5 mm.

Video 1

  • thrombectomy
  • balloon

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Footnotes

  • Contributors Conception and design: RHD, MW, JMD; data acquisition: RHD, MW, HHR, AM, FA, JMC; data analysis and interpretation: all authors; drafting the abstract: RHD, HHR; preparing the video: RHD, MW; final approval: all authors.

  • 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 JMD received a research grant from the National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR001413 to the University at Buffalo; does consulting for Medtronic; receives honoraria from Neurotrauma Science LLC; and has shareholder/ownership interests in Cerebrotech and RIST Neurovascular.

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

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