03:09 PM Abstract No. 161 6-French/088 distal guide sheath access into the petrocavernous internal carotid artery to optimize mechanical thrombectomy

Abstract

Modern stent retriever-based thrombectomy techniques for emergent large vessel occlusions contributed to the successful clinical trials on endovascular acute ischemic stroke intervention. Various adjunctive techniques have been described including the use of a balloon guide catheter (BGC) and/or distal access catheter (DAC) aspiration to improve first pass recanalization, complete reperfusion, and clinical outcomes. We describe a novel technique using a flexible 6French/088 distal guide sheath (DGS), defined as advancement into the petrocavernous internal carotid artery (ICA), to limit antegrade flow without a BGC and reduce the distance/tortuosity for clot extraction. We studied the relative safety and efficacy of DGS placement during standard stent retriever with DAC aspiration thrombectomy A retrospective review of 85 consecutive patients with intracranial ICA or M1-M2 middle cerebral artery (MCA) occlusions underwent stent retriever with DAC aspiration thrombectomy over a 30-month period. Patients were divided based on thrombectomy techniques, conventional stent retriever with DAC aspiration group (traditional group) and using an adjunctive DGS technique (target group). We compared recanalization efficiency (procedure time and passes), reperfusion efficacy using the modified Thrombolysis in Cerebral Ischemia (mTICI) scale, and clinical outcomes of functional independence at 90 days (modified Rankin score 0-2). We identified 36 patients (median age 69 years with NIHSS 18) in the target group and 49 patients (median age 73 years with NIHSS 20) in the traditional group (p=0.11 and 0.12 respectively). There was a trend towards lower groin to revascularization time (53 minutes vs 61 minutes) and lower mean number of thrombectomy attempts in the target group (2.2 vs 2.6), yet those trends did not reach statistical significance. The target group offered higher rates of TICI ≥2 b reperfusion (97% vs 84%; P-value 0.046) that corresponded with increased functional independence at 90 days (65% vs 38%; P=0.03). Optimizing mechanical thrombectomy techniques by advancing a DGS into the petro-cavernous ICA may confer higher reperfusion rates and improved clinical outcomes.