Balloon anchoring technique forthrombectomyin hostile craniocervical arterial anatomy

Abstract

BackgroundCraniocervical 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.MethodsRetrospective 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.ResultsTen 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.ConclusionBAT 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.

Effectiveness of Anchoring with Balloon Guide Catheter and Stent Retriever in Difficult Mechanical Thrombectomy for Large Vessel Occlusion

“…The authors previously reported the improved trackability and stability of BGC during MT with our initial experience of 8F FlowGate2 BGC [ 34 ]. Sharashidze et al [ 22 ] have shown the proximal balloon anchoring with BGC in case with failure of pushing the guidewire into the ICA due to elongation of the arch and tortuosity of the CCA. Balloon inflation of BGC at left CCA enables the positioning of guidewire and co-axial catheter to the left ICA and serial tracing of BGC to the ICA [ 22 ].…”

“…Sharashidze et al [ 22 ] have shown the proximal balloon anchoring with BGC in case with failure of pushing the guidewire into the ICA due to elongation of the arch and tortuosity of the CCA. Balloon inflation of BGC at left CCA enables the positioning of guidewire and co-axial catheter to the left ICA and serial tracing of BGC to the ICA [ 22 ]. Anchored BGC may provide a strong support to allow the advancement of the co-axial device to the distal lesion.…”

“…New generation BGCs such as 8F (FlowGate2, FG2; Stryker Neurovascular, Fremont, CA, USA) and 9F Concentric (Stryker Neurovascular) have various applications in MT with improved accessibility due to good trackability and smooth navigation. BGC with a balloon anchoring technique could be useful for cases with unfavorable anatomy of aortic arch or common carotid artery (CCA) [ 22 ].…”

Balloon anchoring to traverse the sigmoid sinus for delivery of large-caliber venous stents: A technical note

“…9,10 The balloon anchoring technique is one of them, and it has been previously reported that it was feasible in various neuroendovascular therapies. 11,12 However, to the best of our knowledge, there are no reports of the use of this method in sinus stenting cases.…”

A feasible alternative to transfemoral artery access for endovascular revascularization in acute ischemic stroke in cases with difficult vessel anatomy

“…Проблему трудной катетеризации, например при дуге аорты III типа, пытались решить, используя при ТФД баллонный гайд-катетер в качестве якоря для облегчения продвижения катетера для тромбэктомии [23].…”