Combined Aspiration and Stent Retriever Thrombectomy for Distal Carotid Artery Occlusion Using Balloon Guide versus Non-Balloon Guide Catheter

Abstract

Background: The introduction of endovascular thrombectomy dramatically changed acute stroke management and became the standard treatment. Balloon guide catheters provide flow arrest during the clot retrieval process and have several advantages.This study aimed to compare balloon guide catheters (BGCs) versus non-balloon guide catheters (NBGCs) as a part of a combined treatment modality in patients presenting with acute ischemic stroke. Methods: This retrospective study included n = 65 patients who underwent a combined endovascular stroke treatment for distal internal carotid artery (ICA) occlusion. Patients underwent aspiration and stent retriever thrombectomy with the use of BGCs (Group 1, n = 27) or NBGCs (Group 2, n = 38). Results: The groups were compared for outcomes: the National Institutes of Health Stroke Scale (NIHSSS) score change, successful recanalization, good functional outcome at three months, and in-hospital mortality. Conclusion: The two groups didn't differ in terms of the NIHSS score change compared to baseline (p > 0.05). Moreover, there were no significant differences between the two groups in terms of the successful recanalization rate, three-month favorable functional outcome rate, and in-hospital mortality (p = 0.292, p = 0.952, p = 0.178), respectively. Further prospective studies with a larger number of patients and better methodology are warranted.

Keywords: acute ischemic stroke treatment; balloon guide catheter; combined treatment; non-balloon guide catheter; thrombectomy.

Figure 1

(A) Preprocedure CTA of the head (coronal image) indicated that the terminal end of the right ICA was occluded (black arrow). (B) DSA of the right common carotid artery revealed that distal ICA was occluded (black arrow), which includes the supraclinoid segment of the ICA. (C) After the occlusion site was passed with a microcatheter (white arrow), a gentle contrast injection was performed through the microcatheter to verify the placement beyond the clot. (D) A Solitaire 6 × 40 mm stent (white arrow) was used, and 6F intermediate catheter (Sofia) was advanced closer to the thrombus for local aspiration after the stent retriever removal. (E) TICI 2B recanalization was observed after a 1-pass.

Figure 2

(A) Preprocedure CTA of the head indicated that the terminal end of the right ICA was occluded (black arrow) (T occlusion) (B) DSA of the right CCA confirmed the distal ICA occlusion (white arrow). (C) After the occlusion site was passed with a microcatheter, the stent retriever (black arrow) is completely deployed. 5F Catalyst catheter was connected to a Penumbra pump and was placed beyond the face of the thrombus (white arrow) via roadmap imaging. A balloon guide catheter was inserted into the proximal part of the petrous segment of ICA. (D) ICA and MCA were both recanalized with TICI 3 after a 1-pass.

Figure 2

(A) Preprocedure CTA of the head indicated that the terminal end of the right ICA was occluded (black arrow) (T occlusion) (B) DSA of the right CCA confirmed the distal ICA occlusion (white arrow). (C) After the occlusion site was passed with a microcatheter, the stent retriever (black arrow) is completely deployed. 5F Catalyst catheter was connected to a Penumbra pump and was placed beyond the face of the thrombus (white arrow) via roadmap imaging. A balloon guide catheter was inserted into the proximal part of the petrous segment of ICA. (D) ICA and MCA were both recanalized with TICI 3 after a 1-pass.