Balloon-inflation Anchoring Technique for Insertion of a Guiding Catheter in Acute Mechanical Thrombectomy

Abstract

Purpose: Anatomical factors involved in the difficulty of inserting a guiding catheter (GC) into the aortic arch include marked arteriosclerosis with severe vessel tortuosity and type-3/bovine aortic arches. For patients with such factors, we have inserted a balloon guiding catheter (BGC) using the balloon-inflation anchoring technique (BIAT). In this study, we introduce the BIAT, and examine its usefulness. Subjects and Methods:The subjects were 44 patients who underwent acute mechanical thrombectomy for occlusion of the major cerebral artery in anterior circulation between January 2014 and February 2016. Of these, the BIAT was used for BGC insertion in patients, with the above anatomical factors, in whom it was difficult to insert a BGC using the standard method. The BIAT is a technique with a BGC in which an inner catheter is guided to the peripheral side by dilating/anchoring a balloon at maximum at the origin of the brachiocephalic trunk or left common carotid artery, and, subsequently, a BGC is guided to the target blood vessel by slightly deflating the balloon as a flow-guide. Results:Of the 44 patients, BGC insertion was difficult in eight patients (18%). The mean age of the other patients (control group) was 68.9 years, whereas that of the eight patients was 79.7 years, being significantly more advanced (p = 0.025). The BIAT facilitated BGC insertion in all patients, and the technical success rate was 100%. There were no procedure-related complications. The mean interval from the start of femoral artery puncture until BGC insertion was 15.7 and 20.3 minutes, respectively, in the control and BIAT groups. There was no significant difference between the two groups (p = 0.35). Conclusion:In 18% of patients who underwent acute mechanical thrombectomy, BGC insertion was difficult. In this group, the proportion of elderly patients was significantly higher. The BIAT facilitated BGC insertion in all patients. The mean interval from the start of puncture until BGC insertion was 20 minutes; a BGC could be guided in a relatively short period. This procedure may be particularly useful for acute mechanical thrombectomy, of which the duration directly contributes to the outcome.Keywords▶ balloon-inflation anchoring technique, bovine aortic arch, type-3 aortic arch, acute ischemic stroke, thrombectomy

Transradial Approach for Mechanical Thrombectomy of Posterior Circulation Stroke

“…According to several studies, the route was changed, or the use of devices was devised in such patients. [3][4][5][6]11) Of patients with pc-LVO, the prognosis becomes unfavorable in approximately 90% when recanalization is not achieved. On the other hand, recent studies indicated that the endovascular treatment related effective recanalization rate was approximately 70%-80%, and that a favorable outcome was achieved in 30%-40%.…”

“…1,2) With respect to thrombectomy or the recanalization rate, favorable results have been consistently obtained, but we have often encountered patients in whom it was difficult to guide a guiding catheter into an occluded blood vessel, with an increase in the number of patients to be treated by this therapy. [3][4][5][6] Several studies reported that recanalization should be promptly performed to treat posterior circulation large vessel occlusion (pc-LVO), as indicated for the anterior circulation. 7,8) However, when selecting the transfemoral approach (TFA) for patients in whom an approach to the right vertebral artery (VA) is necessary, a specific interval is sometimes required until reaching due to the tortuosity of the aortic arch.…”

High Age Could Influence Large Thrombus Aspiration Catheter Advancement over the Carotid Siphon

“…The inner catheter could be navigated to the peripheral artery with severe vessel tortuosity by dilating/anchoring a balloon of the balloon-guided catheter. 30) This technique could advance the 5MAX ACE more distally. The large aspiration catheter required a coaxial catheter for delivery to MCA.…”

Unfavorable Vascular Anatomy during Endovascular Treatment of Stroke: Challenges and Bailout Strategies

“…Finally, the balloon is deflated and the BGC is advanced over the VDC ( Figure 3H). 26 In some situations, the hook of the VDC hampers its progression into the CCA. In these cases, the VDC can be used to catheterize the innominate or left CCA and an exchange-length Figure 1.…”

“…If it is possible to advance the guidewire distal to this curve, we try to gently to insert the BGC in the take-off of the great vessel of interest and maximally inflate the BGC at the origin of the brachiocephalic trunk or left CCA to provide anchoring to support the distal navigation of the guidewire and VDC ( Figure 3F and G ). Finally, the balloon is deflated and the BGC is advanced over the VDC ( Figure 3H ) [ 26 ]. In some situations, the hook of the VDC hampers its progression into the CCA.…”