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

  • Yi, Ho Jun (Department of Neurosurgery, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Bum-Tae (Department of Neurosurgery, Soonchunhyang University Bucheon Hospital) ;
  • Shin, Dong-Sung (Department of Neurosurgery, Soonchunhyang University Bucheon Hospital)
  • Received : 2021.06.25
  • Accepted : 2021.10.29
  • Published : 2022.07.01

Abstract

Objective : A distal navigation of a large bore aspiration catheter during mechanical thrombectomy (MT) is important. However, delivering a large bore aspiration catheter is difficult to a tortuous or atherosclerotic artery. We report the experience of anchoring with balloon guide catheter (BGC) and stent retriever to facilitate the passage of an aspiration catheter in MT. Methods : When navigating an aspiration catheter failed with a conventional co-axial microcatheter delivery, an anchoring technique was used. Two types of anchoring technique were applied to facilitate distal navigation of a large bore aspiration catheter during MT. First, a passage of aspiration catheter was attempted with a proximal BGC anchoring technique. If this technique also failed, another anchoring technique with distal stent retriever was tried. Consecutive patients who underwent MT with an anchoring technique were identified. Details of procedure, radiologic outcomes, and safety variables were evaluated. Results : A total of 67 patients underwent MT with an anchoring technique. Initial trial of aspiration catheter passage with proximal BGC anchoring technique was successful for 35 patients (52.2%) and the second trial with distal stent retriever anchoring was successful for 32 patients (47.8%). Overall, navigation of a large bore aspiration catheter was successful for all patients (100%) without any procedure related complications. Conclusion : Our study showed the usefulness of anchoring technique with proximal BGC and distal stent retriever during MT, especially in those with an unfavorable anatomical structure. This technique could be an alternative option for delivering an of aspiration catheter to a distal location.

Keywords

Acknowledgement

This study was supported by the National Research Foundation of Korea (NRF-2021R1G1A1094797) and the Soonchunhyang University Research Fund.

References

  1. Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG : Classification of stroke subtypes. Cerebrovasc Dis 27 : 493-501, 2009 https://doi.org/10.1159/000210432
  2. Crowley RW, Abla AA, Ducruet AF, McDougall CG, Albuquerque FC : Novel application of a balloon-anchoring technique for the realignment of a prolapsed pipeline embolization device: a technical report. J Neurointerv Surg 6 : 439-444, 2014 https://doi.org/10.1136/neurintsurg-2013-010806
  3. Fargen KM, Velat GJ, Lawson MF, Hoh BL, Mocco J : The stent anchor technique for distal access through a large or giant aneurysm. J Neurointerv Surg 5 : e24, 2013 https://doi.org/10.1136/neurintsurg-2012-010276
  4. Goto S, Ohshima T, Ishikawa K, Yamamoto T, Shimato S, Nishizawa T, et al. : A stent-retrieving into an aspiration catheter with proximal balloon (ASAP) technique: a technique of mechanical thrombectomy. World Neurosurg 109 : e468-e475, 2018 https://doi.org/10.1016/j.wneu.2017.10.004
  5. Goyal M, Menon BK, Van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. : Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 23 : 387, 2016
  6. Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, et al. : Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359 : 1317-1329, 2008 https://doi.org/10.1056/NEJMoa0804656
  7. Hopf-Jensen S, Preiss M, Marques L, Lehrke S, Schattschneider J, Stolze H, et al. : Impact and effectiveness of dual aspiration technique in stent-assisted mechanical thrombectomy: recent improvements in acute stroke management. Cardiovasc Intervent Radiol 39 : 1620-1628, 2016 https://doi.org/10.1007/s00270-016-1404-4
  8. Kang DH, Park J : Endovascular stroke therapy focused on stent retriever thrombectomy and direct clot aspiration: historical review and modern application. J Korean Neurosurg Soc 60 : 335-347, 2017 https://doi.org/10.3340/jkns.2016.0809.005
  9. Kim SH, Lee H, Kim SB, Kim ST, Baek JW, Heo YJ, et al. : Hybrid mechanical thrombectomy for acute ischemic stroke using an intermediate aspiration catheter and Trevo stent simultaneously. J Clin Neurosci 76 : 9-14, 2020 https://doi.org/10.1016/j.jocn.2020.04.079
  10. Lapergue B, Blanc R, Guedin P, Decroix JP, Labreuche J, Preda C, et al. : A direct aspiration, first pass technique (ADAPT) versus stent retrievers for acute stroke therapy: an observational comparative study. AJNR Am J Neuroradiol 37 : 1860-1865, 2016 https://doi.org/10.3174/ajnr.A4840
  11. Lee DH, Sung JH, Kim SU, Yi HJ, Hong JT, Lee SW : Effective use of balloon guide catheters in reducing incidence of mechanical thrombectomy related distal embolization. Acta Neurochir (Wien) 159 : 1671-1677, 2017 https://doi.org/10.1007/s00701-017-3256-3
  12. Li ZS, Zhou TF, Li Q, Guan M, Liu H, Zhu LF, et al. : Endovascular management of intracranial atherosclerosis-related large vessel occlusion with the a direct aspiration first-pass thrombectomy compared with solumbra technique. Front Neurol 12 : 643633, 2021 https://doi.org/10.3389/fneur.2021.643633
  13. Lin CM, Wu YM, Chang CH, Chen CC, Wang AY : The ANTRACK technique: employing a compliant balloon or stent retriever to advance a large-bore catheter to an occlusion during thrombectomy procedures in acute stroke patients. Oper Neurosurg (Hagerstown) 16 : 692-699, 2019 https://doi.org/10.1093/ons/opy202
  14. Mascitelli JR, Pain M, Zarzour HK, Baxter P, Ghatan S, Mocco J : Sinus thrombectomy for purulent cerebral venous sinus thrombosis utilizing a novel combination of the trevo stent retriever and the penumbra ACE aspiration catheter: the stent anchor with mobile aspiration technique. J Neurointerv Surg 8 : e24, 2016 https://doi.org/10.1136/neurintsurg-2015-011782.rep
  15. Maus V, Behme D, Kabbasch C, Borggrefe J, Tsogkas I, Nikoubashman O, et al. : Maximizing first-pass complete reperfusion with SAVE. Clin Neuroradiol 28 : 327-338, 2018 https://doi.org/10.1007/s00062-017-0566-z
  16. Munich SA, Vakharia K, Levy EI : Overview of mechanical thrombectomy techniques. Neurosurgery 85(Suppl 1) : S60-S67, 2019 https://doi.org/10.1093/neuros/nyz071
  17. Nguyen TN, Malisch T, Castonguay AC, Gupta R, Sun CH, Martin CO, et al. : Balloon guide catheter improves revascularization and clinical outcomes with the solitaire device: analysis of the north american solitaire acute stroke registry. Stroke 45 : 141-145, 2014 https://doi.org/10.1161/strokeaha.113.002407
  18. Nikoubashman O, Nikoubashman A, Busen M, Wiesmann M : Necessary catheter diameters for mechanical thrombectomy with ADAPT. AJNR Am J Neuroradiol 38 : 2277-2281, 2017 https://doi.org/10.3174/ajnr.A5401
  19. Oh JS, Yoon SM, Shim JJ, Doh JW, Bae HG, Lee KS : Efficacy of balloon-guiding catheter for mechanical thrombectomy in patients with anterior circulation ischemic stroke. J Korean Neurosurg Soc 60 : 155-164, 2017 https://doi.org/10.3340/jkns.2016.0809.003
  20. Ohshima T, Miyachi S : A novel technique for mitigation of the ledge effect caused by the use of a large-lumen catheter during neurointervention: beanstalk method. Asian J Neurosurg 15 : 753-755, 2020 https://doi.org/10.4103/ajns.ajns_238_20
  21. Romano DG, Frauenfelder G, Casseri T, Piano M, Vinci S, Comai A, et al. : Efficacy of ADAPT with large-bore reperfusion catheter in anterior circulation acute ischemic stroke: a multicentric italian experience. Radiol Med 125 : 57-65, 2020 https://doi.org/10.1007/s11547-019-01069-x
  22. Sharashidze V, Nogueira RG, Al-Bayati AR, Grossberg JA, Haussen DC : Balloon anchoring technique for thrombectomy in hostile craniocervical arterial anatomy. J Neurointerv Surg 12 : 763-767, 2020 https://doi.org/10.1136/neurintsurg-2019-015347
  23. Singh J, Wolfe SQ, Janjua RM, Hedayat H, Burnette C : Anchor technique: use of stent retrievers as an anchor to advance thrombectomy catheters in internal carotid artery occlusions. Interv Neuroradiol 21 : 707-709, 2015 https://doi.org/10.1177/1591019915609170
  24. Snyder KV, Natarajan SK, Hauck EF, Mocco J, Siddiqui AH, Hopkins LN, et al. : The balloon anchor technique: a novel technique for distal access through a giant aneurysm. J Neurointerv Surg 2 : 363-367, 2010 https://doi.org/10.1136/jnis.2009.002006
  25. Takahira K, Kataoka T, Ogino T, Endo H, Nakamura H : Efficacy of a coaxial system with a compliant balloon catheter for navigation of the penumbra reperfusion catheter in tortuous arteries: technique and case experience. J Neurosurg 126 : 1334-1338, 2017 https://doi.org/10.3171/2016.3.JNS152790
  26. Turk AS, Frei D, Fiorella D, Mocco J, Baxter B, Siddiqui A, et al. : ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy. J Neurointerv Surg 6 : 260-264, 2014 https://doi.org/10.1136/neurintsurg-2014-011125
  27. Turk AS, Frei D, Fiorella D, Mocco J, Baxter B, Siddiqui A, et al. : ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy. J Neurointerv Surg 10(Suppl 1) : i4-i7, 2018 https://doi.org/10.1136/neurintsurg-2014-011125.rep
  28. Uysal E, Caliskan C, Caymaz I, Orken DN, Basak M : Stenting of vertebral artery origin with the buddy wire technique in tortuous subclavian artery. A case report. Interv Neuroradiol 16 : 175-178, 2010 https://doi.org/10.1177/159101991001600209
  29. Vakharia K, Munich SA, Tso MK, Waqas M, Levy EI : Stent anchor technique to reduce microcatheter loop for stent-assisted coiling of anterior communicating artery aneurysm. Neurosurg Focus 46(Suppl 1) : V8, 2019
  30. Woo HG, Sunwoo L, Jung C, Kim BJ, Han MK, Bae HJ, et al. : Feasibility of permanent stenting with solitaire FR as a rescue treatment for the reperfusion of acute intracranial artery occlusion. AJNR Am J Neuroradiol 39 : 331-336, 2018 https://doi.org/10.3174/ajnr.A5477
  31. Yi HJ, Lee DH, Sung JH : Clinical usefulness of waiting after stent deployment in mechanical thrombectomy: effect of the clot integration. World Neurosurg 119 : e87-e93, 2018 https://doi.org/10.1016/j.wneu.2018.07.040
  32. Yi HJ, Sung JH, Lee DH : Preliminary experience of neuroform atlas stenting as a rescue treatment after failure of mechanical thrombectomy caused by residual intracranial atherosclerotic stenosis. J Korean Neurosurg Soc 64 : 198-206, 2021 https://doi.org/10.3340/jkns.2020.0146
  33. Yi HJ, Sung JH, Lee DH, Song SY : Effectiveness and technical considerations of solitaire platinum 4×40 mm stent retriever in mechanical thrombectomy with solumbra technique. J Korean Neurosurg Soc 64 : 30-38, 2021 https://doi.org/10.3340/jkns.2020.0046
  34. Yi HJ, Sung JH, Lee MH, Lee DH : Experience of the new flowgate2 device as a balloon guide catheter for ischemic stroke intervention. World Neurosurg 126 : e736-e742, 2019 https://doi.org/10.1016/j.wneu.2019.02.140
  35. Yoo AJ, Frei D, Tateshima S, Turk AS, Hui FK, Brook AL, et al. : The penumbra stroke system: a technical review. J Neurointerv Surg 4 : 199-205, 2012 https://doi.org/10.1136/neurintsurg-2011-010080