Dissection of Extracranial Internal Carotid Artery Due to Balloon Guiding Catheter Resulting in Asymptomatic Internal Carotid Artery Occlusion

Akpınar, Süha; Yılmaz, Güliz

doi:10.5812/iranjradiol.28209

Cited by 11 publications

(4 citation statements)

References 10 publications

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“…In addition, there may be concerns for complications such as dissection related to distal navigation of the BGC into the distal cervical ICA. 12,13 The purpose of this study was to compare the impact of BGC locations in patients treated for anterior circulation acute ischemic stroke by mechanical thrombectomy.…”

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confidence: 99%

Impact of Balloon-Guiding Catheter Location on Recanalization in Patients with Acute Stroke Treated by Mechanical Thrombectomy

Jeong

Kim

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Mechanical thrombectomy with proximal flow control and forced aspiration may improve the outcome of endovascular revascularization therapy for patients with acute stroke. The purpose of this study was to compare the impact of balloon-guiding catheter locations in patients treated for anterior circulation acute ischemic stroke using mechanical thrombectomy. MATERIALS AND METHODS: The influence of the balloon-guiding catheter location (proximal, balloon-guiding catheter tip proximal to C1 vertebral body; distal, between the skull base and the C1 vertebral body) was analyzed in patients with acute anterior circulation stroke treated with stent-retriever thrombectomy. The baseline angiographic/clinical characteristics, time intervals, recanalization rates, and clinical outcomes were compared. RESULTS: The clinical analysis included 102 patients (mean age, 69.5 Ϯ 12.8 years; male/female ratio ϭ 52:50). The balloon-guiding catheter was located distally in 49 patients and proximally in 53 patients for flow control and forced aspiration during stent retrieval. The puncture-to-recanalization time was shorter in the distal group than in the proximal group (40 versus 56 minutes, P ϭ .02). Successful and complete recanalizations were more frequently achieved in the distal group compared with the proximal group (98.0% versus 75.5%. P ϭ .003; 67.3% versus 45.3%, P ϭ .04, respectively). Multivariate analysis showed that the distal catheterization location was independently associated with successful recanalization (adjusted OR, 13.4; 95% CI, 2.4-254.8; P ϭ .02). CONCLUSIONS: Location of the balloon-guiding catheter has a significant impact on recanalization in patients with acute stroke. The balloon-guiding catheter should be positioned as distally as safely possible in the cervical ICA for maximally effective thrombectomy.

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confidence: 99%

Impact of Balloon-Guiding Catheter Location on Recanalization in Patients with Acute Stroke Treated by Mechanical Thrombectomy

Jeong

Kim

et al. 2019

AJNR Am J Neuroradiol

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“…An ICA dissection case has been reported that was caused by repetitive movement of the balloon guiding catheter during thrombectomy for acute ischemic stroke. 15) The balloon was not bale-shaped dilated but vascular traction was performed with the minimum necessary dilatation. In the present case, a balloon guiding catheter could be inserted into the origin of ICA, but if it can only be inserted into the common carotid artery, embolic protection devices during stent deployment are required.…”

Section: Discussionmentioning

confidence: 99%

Carotid Artery Stenting Using the Snake Hunt Technique for Highly Tortuous Carotid Artery Stenosis: A Technical Note

Koide

Ito

Hino

et al. 2021

NMC Case Report Journal

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In carotid artery stenting (CAS) for highly tortuous carotid stenosis, it is often difficult to guide rigid devices such as carotid stents. There are various adjunctive techniques using a guidewire: the buddy wire technique, the sheep technique, and the stiff guide technique. We report a case in which the tortuous vessel was straightened and a stent could be inserted. A 64-year-old man with amaurosis had highly tortuous left carotid stenosis. Despite the best medical treatments, he often had transient cerebral ischemic symptoms, so we planned CAS. We could insert the first stent, but the proximal vessel was kinked by the placement of the stent. It was so tortuous that the second stent could not be inserted by adjunctive techniques. Therefore, the proximal balloon was inflated and pulled back to straighten the tortuous vessel, and then we could insert the stent. We named this technique the “snake hunt technique” because it was just like catching a snake given that the tortuous vessel was stretched. This technique could be a troubleshooting step when it is difficult to insert a stiff device such as a stent or balloon even with the use of various adjunctive techniques.

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“…On the other hand, the incidence of iatrogenic artery dissection during reperfusion therapy for acute cerebral infarction is relatively high (1.0%–3.9%). 4 , 5 , 9 , 15 , 16) Several reasons for this are as follows: a guidewire and catheter are guided to an occluded artery in the absence of a roadmap 9) ; a relatively thick guidewire and catheter are guided several times 9) ; stent retriever traction-related vascular injury 17 , 18) ; a guiding catheter with a balloon is used 11) ; excessive suction through a catheter for the purpose of thrombus aspiration 12) ; rotation of head and neck affects the shapes of extracranial blood vessels during reperfusion therapy under local anesthesia in most patients, making the use of a roadmap impossible; and early recanalization is goal, making guidewire/catheter operations relatively rough. Furthermore, 1.5% 2) and 16.7% 1) of patients with iatrogenic artery dissection during cerebral angiography or neuroendovascular treatment required stenting, respectively, whereas 44.4% 9) of patients with iatrogenic artery dissection during reperfusion therapy for acute cerebral infarction required it; the percentage was relatively high.…”

Section: Discussionmentioning

confidence: 99%

Two Patients Who Underwent Emergency Stenting for Iatrogenic Cervical Internal Carotid Artery Dissection during Thrombectomy

Tsujimoto

Ikeda

Otsuka

et al. 2020

JNET

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Iatrogenic artery dissection during reperfusion therapy is one of the complications causing a poor prognosis. We report two cases of emergent stent placement for iatrogenic cervical carotid artery dissection during reperfusion therapy for acute ischemic stroke. Case Presentation: Two patients, a 77-year-old woman and a 77-year-old man, were diagnosed with acute major cerebral artery occlusion, and underwent reperfusion therapy. The iatrogenic internal carotid artery dissection was caused by derivation of a 6-Fr catheter and 0.014-inch wire in the tortuous cervical internal carotid artery, and emergent stent placement was performed. Recanalization was confirmed and no deterioration caused by the iatrogenic dissection was found. Conclusion: In patients in whom cerebral infarction is localized on MRI, additional stent placement may be effective for preventing adverse events caused by iatrogenic cervical internal carotid artery dissection during reperfusion therapy for intracranial cerebral artery occlusion related to atherosclerotic change. Keywords▶ acute ischemic stroke, carotid artery, iatrogenic dissection, reperfusion therapy, stent whether the treatment of a target lesion should be continued or whether iatrogenic artery dissection should be managed. 3) Several studies have suggested the usefulness of reperfusion therapy for anterior circulation major artery occlusion, 4-8) but iatrogenic artery dissection during this therapy may lead to an unfavorable outcome; this must always be considered. 9) Few studies have reported iatrogenic artery dissection during reperfusion therapy for acute cerebral infarction. 9-12) To our knowledge, no study has described the details of patients in whom emergency stenting for iatrogenic artery dissection led to a favorable postoperative course. In this study, we report two patients in whom emergency stenting for iatrogenic cervical internal carotid artery dissection, which occurred after introducing a 6-Fr catheter and 0.014-inch wire during reperfusion therapy for acute cerebral infarction, resulted in a favorable postoperative course. Case Presentation Case 1 The patient was a 77-year-old, right-handed female. There was no medical or smoking history. Dysarthria and paralysis of This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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Dissection of Extracranial Internal Carotid Artery Due to Balloon Guiding Catheter Resulting in Asymptomatic Internal Carotid Artery Occlusion

Cited by 11 publications

References 10 publications

Impact of Balloon-Guiding Catheter Location on Recanalization in Patients with Acute Stroke Treated by Mechanical Thrombectomy

Impact of Balloon-Guiding Catheter Location on Recanalization in Patients with Acute Stroke Treated by Mechanical Thrombectomy

Carotid Artery Stenting Using the Snake Hunt Technique for Highly Tortuous Carotid Artery Stenosis: A Technical Note

Two Patients Who Underwent Emergency Stenting for Iatrogenic Cervical Internal Carotid Artery Dissection during Thrombectomy

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