Initial Clinical Experience of Repeat Thrombectomy with a Retrieval Stent (RTRS) with Continuous Proximal Flow Arrest by Balloon Guide Catheter for Acute Intracranial Carotid Occlusion.

Wen-Huo Chen,Zhi-Nan Pan,Tingyu Yi,Rong-Cheng Chen,Ding-Lai Lin,Yan-Min Wu,Xiao-Hui Lin,Xiu-Fen Zheng,Muh-Shi Lin

doi:10.1155/2021/7607324

Wen-Huo Chen, Zhi-Nan Pan + Show 7 more

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https://doi.org/10.1155/2021/7607324

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Journal: Behavioural neurology	Publication Date: Dec 31, 2021
Citations: 1	License type: CC BY 4.0

Affiliation: Fujian Medical University

Abstract

Background Balloon guide catheters (BGCs) have good performance in terms of radiological outcomes in acute ischemic thrombectomy. It is not uncommon for BGCs to be blocked by thrombi, especially in cases with acute intracranial internal carotid artery (ICA) occlusion. Our initial experience using repeat thrombectomy with a retrieval stent (RTRS) with continuous proximal flow arrest by BGC for acute intracranial ICA occlusion is presented. Methods In patients with acute intracranial ICA occlusion treated with RTRS, clinical data, including the National Institutes of Health Stroke Scale (NIHSS) score at admission and modified Rankin Scale (mRS) score at 90 days, and procedural data, including the Extended treatment in Cerebral Infarction (eTICI) score, procedural time, and complications, were analyzed. Results Thirty-two consecutive patients (12 men (37.5%); mean age: 73 years) were treated with RTRS using a BGC. The median NIHSS score was 19. The median puncture-to-reperfusion time was 46 minutes (range: 22-142 minutes). All patients were successfully revascularized; eTICI 2c or better recanalization was achieved in 30 (93.8%) patients. No procedure-related complications or symptomatic intracranial hemorrhage occurred. Two cases (6.3%) had distal emboli, but none had emboli to the anterior cerebral artery. Fourteen patients (43.8%) achieved a good outcome with an mRS score of 0–2 at 90 days, and 8 patients (25.0%) died. Conclusions In patients with intracranial ICA occlusion, RTRS with proximal flow arrest by BGC is effective and safe, achieving good clinical and angiographic outcomes. This method may reduce the incidence of distal emboli in thrombectomy with stent retrievers.

Highlights

Acute intracranial internal carotid artery (ICA) occlusion, especially carotid T occlusion, is often associated with a large clot burden, low clot burden score, poor collateral flow, and poor outcome, resulting in a large ICA territory infarction [1]
From 1 January 2015 to 1 November 2020, there were 426 patients with acute intracranial ICA occlusion, and Balloon guide catheters (BGCs) were used in 116 patients
The BGC was blocked by a thrombus after the first pass of stent retrievers (SRs), allowing no blood flow out of the BGC, in 40 patients (36 cases with 8F Merci, 4 cases with 8F Flowgate 2), and the retrieval stent (RTRS) technique was applied in 32 patients

Summary

Introduction

Acute intracranial internal carotid artery (ICA) occlusion, especially carotid T occlusion, is often associated with a large clot burden, low clot burden score, poor collateral flow, and poor outcome, resulting in a large ICA territory infarction [1]. Our initial experience using repeat thrombectomy with a retrieval stent (RTRS) with continuous proximal flow arrest by BGC for acute intracranial ICA occlusion is presented. In patients with acute intracranial ICA occlusion treated with RTRS, clinical data, including the National Institutes of Health Stroke Scale (NIHSS) score at admission and modified Rankin Scale (mRS) score at 90 days, and procedural data, including the Extended treatment in Cerebral Infarction (eTICI) score, procedural time, and complications, were analyzed. In patients with intracranial ICA occlusion, RTRS with proximal flow arrest by BGC is effective and safe, achieving good clinical and angiographic outcomes. This method may reduce the incidence of distal emboli in thrombectomy with stent retrievers

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