Percutaneous Balloon Angioplasty for Acute Occlusion of Intracranial Arteries

Kim

J Cerebrovasc Endovasc Neurosurg

et al. 2012

Objective : We report on our experience using a compliant balloon for treatment of thrombi resistant to simple mechanical thrombolysis.Methods : We conducted a retrospective investigation of 46 consecutive acute ischemic stroke patients who were treated by intraarterial thrombolysis (IAT) between January 2008 and July 2010. We compared IAT results between the balloon group (BG) and the simple mechanical thrombolysis (with microcatheter and microguidewire) group (SG). The Thrombolysis in Myocardial Infarction (TIMI) grading system was used for grading of the degrees of vessel recanalization. In addition, a modified Thrombolysis in Cerebral Infarction (TICI) score was used for post-IAT TIMI grade 2 patients. Modified Rankin Scale scores were used at three months for assessment of clinical outcomes.Results : Twenty of the 46 subjects were treated with a compliant balloon. The mean initial National Institutes of Health Stroke Scale score was 15.1 in the BG and 14 in the SG. The mean time from symptom onset to initiation of IAT was 225 minutes in the BG and 177 in the SG (p = 0.004). The overall rate of successful recanalization (TIMI grade 2 or 3) was 85% in the BG and 73% in the SG (p = 0.476). In the TIMI grade 2 group, modified TICI 2b was 90% in the BG and 16% in the SG (p = 0.001). Postprocedure intraparenchymal hemorrhage occurred in two subjects in the BG and 10 subjects in the SG (p = 0.029). No significant difference in clinical outcomes was observed between the BG and SG (p = 0.347).Conclusions : The compliant balloon showed high potential for recanalization following acute ischemic stroke, especially when simple mechanical thrombolysis had failed.

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Usefulness of Compliant Balloon for Recanalization of Acute Ischemic Stroke

Kim

J Cerebrovasc Endovasc Neurosurg

et al. 2012

Journal of the American College of Cardiology

“…Previous reports have shown successful reperfusion with catheter-based therapy (CBT) in selected patients [6][7][8][9]. Because only a small percentage of ischemic stroke patients are candidates for intravenous thrombolysis, there is a need for additional therapeutic options for the management of AIS [10].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Outcomes With Catheter-Based Therapy for Acute Stroke

Htyte

Jaffe

Parto

et al. 2014

Background: Timely reperfusion directly impacts favorable neurologic outcomes in acute ischemic stroke (AIS) patients. Most strokes present outside the 3-4.5 h window for intravenous thrombolysis (IV-tPA). Catheter-based therapy (CBT) is commonly used in patients not eligible for timely IV-tPa, but variables that predict good neurologic outcomes are poorly understood. Methods: Results of 124 consecutive AIS patients who received CBT at Ochsner Medical Center from 2006 and 2012 are reported. A modified Rankin score (mRs) of 2 at 90 day post-CBT was used as the primary measurement of a good neurologic outcome. All-cause mortality during the index hospitalization, 30 days from treatment, and at 1 year were reported. Results are reported as those treated by Interventional Cardiologists (IC) or by Neurointerventionalists (NI). Results: The mean age was 65 6 16 years of which 48% (n 5 52) were male. The mean NIHSS was 15.0 6 7.5. Thrombolysis in cerebral infarction (TICI) 2 flow was achieved in 80% (n 5 100). Good neurologic outcome was observed in 64% (n 5 37 of 58) of patients 65 years or younger while in those older than 65, only 36% (n 5 24 of 66) had the same outcome (P 5 0.002). Mortality at 30 days for the two age groups were 21% (n 5 12) vs. 50% (n 5 33) (P 5 <0.001) respectively. A good neurologic outcome at 90 days was seen in 57% of patients with restoration of TICI 2 flow compared to 17% with TICI < 2 flow (P 5 <0.001). Those with failed reperfusion (TICI<2 flow) had 30-day mortality rate of 54% (13 of 24) vs. 20% (19 of 97) in those with TICI 2 flow (P 5 <0.001). At 90 days, there was no significant differences in patient outcomes between IC (n 5 58) and NI (n 5 66) treated patients. Conclusion: Successful revascularization with CBT leads to a good neurologic outcome in selected stroke patients. Medical co-morbidities and increased age > 65 years contributed to poor outcomes. To support broadening the number of physicians qualified to perform catheter-based stroke interventions, this study demonstrates that IC participating on a stroke team achieve comparable outcomes to NI. V C 2014 Wiley Periodicals, Inc.

“…When pharmacological rescue fails, mechanical flow restoration attempts can be useful 3. Balloon catheter disruption of thrombus with mechanical revascularization has been reported to be effective in patients with acute ischemic stroke, but little has been reported on its usefulness as a rescue therapy during neuroendovascular procedures 4 5. Recently, new coaxial dual-lumen cerebral balloon catheters compatible with 0.014 inch guidewires have been developed to improve steerability and trackability while maintaining excellent balloon inflation compliance 6–9.…”

Section: Introductionmentioning

confidence: 99%

Mechanical revascularization of acute iatrogenic anterior cerebral artery occlusions: use of a new coaxial dual-lumen balloon catheter results in rapid access and flow restoration

2012

SUMMARYAcute iatrogenic occlusion of cerebral vessels is a risk during the performance of neuroendovascular procedures. Most commonly this is a result of thrombus formation within the vessel, thromboembolism or an acute vasospastic response. There are several options for flow restoration including pharmacological, mechanical and microsurgical. Mechanical flow restoration, usually by thrombectomy, is typically performed in large cerebral vessels. Current mechanical thrombectomy devices have limited utility in smaller vessels that are more difficult to access, such as the anterior cerebral artery (ACA). We present two cases where successful flow restoration of an intraoperative acutely occluded or thrombotic ACA was rapidly achieved by balloon dilation using a new coaxial dual-lumen balloon catheter. The time elapsed from the decision to use the balloon catheter until revascularization for each patient was 5 min and 46 s (case 1) and 10 min and 25 s (case 2). BACKGROUND