Balloon Guide Catheter Research Articles

Mechanical Thrombectomy for Acute Common Carotid Artery Occlusion.

Mechanical thrombectomy (MT) is the standard treatment for acute large occlusion of the cerebral artery. Evidence for the success of this procedure was based on the treatment of patients with internal carotid artery and middle cerebral artery thrombi. There are a few reports on thrombi extending to the common carotid artery (CCA). We document our endovascular procedure and the clinical outcome in seven consecutive patients who underwent MT for CCA thrombi between September 2016 and April 2021. Their mean National Institutes of Health Stroke Scale score was 20.0 (range, 9-30), and the mean diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score on magnetic resonance images was 8.7 (range, 7-10). In six patients, MT of the CCA occlusion was successful, and the mean puncture-to-reperfusion time was 84 minutes (range, 39-211 minutes). In five patients, successful reperfusion was obtained. The mean total pass number was 4.1 (range, 2-7). Due to large thrombi, we performed balloon guide catheter (BGC) occlusion in three patients. Sheath occlusion occurred in two, and thrombus migration into the femoral artery around the sheath was observed in two patients. The mean modified Rankin Scale score 3 months post-stroke was 3.6 (range, 2-5). When the removal of a large CCA thrombus is attempted in a single step, catheter and sheath occlusion may occur, and this increases the risk for critical systemic artery occlusion. Therefore, we suggest that MT be combined with the BGC technique and propose the use of a large aspiration catheter to decrease the volume of the thrombus.

Effect of Early Balloon Inflation of Balloon Guide Catheter in Mechanical Thrombectomy for Large Vessel Occlusion.

A balloon guide catheter (BGC) is widely used in mechanical thrombectomy (MT). However, the balloon inflation timing of BGC has not been clearly established. We evaluated whether balloon inflation timing of BGC affects the results of MT. Patients who underwent MT with BGC for anterior circulation occlusion were enrolled. Patients were dichotomized into early and late balloon inflation groups, according to the timing of BGC inflation. Angiographic and clinical outcomes were compared between the two groups. Multivariable analyses were performed to evaluate the predictive factors for first-pass reperfusion (FPR) and successful reperfusion (SR). Of 436 patients, the early balloon inflation group showed a shorter procedure time (21 min [11-37] vs. 29 min [14-46], P = 0.014), a higher rate of SR with aspiration only (64.0% vs. 55.4%, P=0.016), a lower aspiration catheter delivery failure rate (11.1% vs. 19.4%, P = 0.005), less frequent technique conversion (36.0% vs. 44.5%, P = 0.009), higher rate of FPR (58.2% vs. 50.2%, P = 0.011), and a lower rate of distal embolization (7.9% vs. 11.7%, P = 0.006), compared to the late balloon inflation group. In multivariate analysis, early balloon inflation was an independent predictor for FPR (odds ratio, OR 1.53, 95% confidence interval, CI 1.37-2.57; P = 0.011) and SR (OR 1.26, 95% CI 1.18-1.64; P = 0.018). Early balloon inflation of BGC enables an effective procedure than late balloon inflation. Early balloon inflation was associated with higher rates of FPR and SR.

Comparison of mechanical thrombectomy techniques in an in vitro stroke model: How to obtain a first pass recanalization?

BackgroundSince mechanical thrombectomy (MT) has proven to be effective in the treatment of acute ischemic stroke (AIS), significant research has been dedicated to establishing procedural techniques offering best rate of first pass effect (FPE). In this study, we compared the efficacy of different techniques in vitro to achieve the first pass recanalisation (FPR). MethodsIn vitro MT procedures were performed using a realistic silicone model of the human cerebral vasculature. The MT with stent retriever (SR) were performed with manual co-aspiration through the respective access catheter and intermediate catheter (IC), with Solumbra or partial retrieval techniques into the IC. Two SRs (Solitaire and EmboTrap) were selected to retrieve both red blood cells (RBC) rich and fibrin-rich clots. FPR rates were recorded for each case. ResultsOverall, 144 MT were performed. FPR rates using the partial retrieval and Solumbra technique were of 100% and 87%, respectively (p = 0.01). The rate of FPR was of 92% using the balloon-guide catheter (BGC) compared to 64% with the guide catheter (GC) (p = 0.0001). With an IC, no differences were found between using a BGC or a GC (87.9% vs 89,6%, p = 0.75). No significant difference was observed between the Embotrap and the Solitaire device for the rate of FPR (82% and 74%, respectively; p = 0.23). ConclusionsIn this study, FPR rates were higher with the use of an IC associated with the partial retrieval technique, regardless the guide catheter, the SR, or the clot composition. The less effective technique was the association of GC and SR, without an IC.

Support and guide performance comparison of balloon guide catheters.

Several types of balloon guide catheters (BGCs) are used in mechanical thrombus retrieval. However, direct comparisons of their supporting and guiding performance have not been reported. We compared the supporting and guiding performance of the Branchor, Flowgate, and Optimo BGCs using a type 3 aorta artificial vascular model. An inner catheter was pushed into the artificial vascular model using a linear actuator for the supporting performance evaluation. A previously placed BGC in the internal carotid artery was then intentionally caused to slip. Supporting performance was evaluated by measuring the distance the BGC slipped and generated maximum resistance during Inner catheter insertion. For the guiding performance experiment, a linear actuator was used to guide the BGC into the internal carotid artery of the artificial vessel model. The guiding performance was evaluated by measuring the distance reached by the BGC, maximum resistance generated during insertion of the guiding catheter, and distance the inner catheter slipped. Each experiment was replicated 5 times. No statistically significant differences were observed in the results of the five supporting performance experiments. However, the results of the first and second experiments suggested that the Optimo offers better supporting performance. In the guiding performance experiment, significant differences were observed, suggesting that the Branchor and Flowgate have superior guiding performance in comparison with the Optimo. The Optimo offered superior supporting performance, while the Branchor and Flowgate showed better guiding performance than the Optimo.

Carotid Artery Stenting Using the Walrus Balloon Guide Catheter With Flow Reversal for Proximal Embolic Protection: Technical Description and Single-Center Case Series.

The use of modern transfemoral balloon guide catheters (BGC) for flow reversal during carotid artery stenting is scarcely described in the literature but represents a promising and efficient technique for embolic protection. To describe a flow-reversal technique using the Walrus BGC (Q'Apel Medical Inc.) and report our center's experience. We performed a retrospective analysis of data for consecutive patients aged 18 years or older who underwent elective carotid artery stenting with the use of flow reversal through the Walrus BGC between July 2020 and September 2021. Patient characteristics, procedural details, and clinical follow-up were evaluated. One hundred and five patients were included. Mean age was 69.8 ± 9.4 years, and 36 (34.3%) were women. The most common comorbidities were hyperlipidemia (76.2%) and hypertension (57.1%). Fifty-nine (56.2%) patients were symptomatic. Ninety-nine (94.3%) patients had stenosis ≥70%. Contralateral stenosis ≥50% was present in 44 patients (41.9%). Distal filters were used after flow reversal was established in 90 patients (85.7%). Angioplasty was performed in 85 patients (80.9%). Stenting was successful in 100% of cases. No periprocedural transient ischemic attacks (TIAs) or strokes occurred. Stroke occurred in 2 patients (1.9%) during the 30-day follow-up period, resulting in 1 (0.9%) death. In our experience, this technique was safe, feasible, and efficient, with 100% technical success and no periprocedural thromboembolic complications. More extensive studies are needed to establish the role of proximal protection with flow reversal using modern BGCs.

Efficacy of Balloon Guide Catheter-Assisted Thrombus Repair in Stroke Treatment: A Retrospective Survey in China.

Background The first-pass (FP) effect, defined by successful cerebral reperfusion from a single pass of an endovascular stentriever, was associated with shorter procedural times and possible improved outcomes in patients with ischemic stroke secondary to large vessel occlusion. The adjunctive use of balloon guide catheter (BGC) may increase the rates of the first-pass effect. In this retrospective study we examined the impact of BGC on the first-pass effect in acute stroke patients. Methods We included patients with acute ischemic stroke with large vessel occlusion treated by endovascular thrombectomy from 2018 to 2019. We categorized the cases into BGC and non-BGC groups. Differences in time metrics and outcomes were compared. Result One hundred and thirty-two patients were included, and sixty-two were in BGC group (47.0%). The median procedural time was shorter (83.0 minutes vs 120.0 minutes, P = 0.000), and FP rate was higher in BGC group (58.1% vs 32.9%, P = 0.004) compared with non-BGC group. Proportion of modified Thrombolysis in Cerebral Infarction (mMTICI) 3 was higher (66.1% vs 37.1%, P = 0.001), and modified Rankin Scale (mRS) 0 to 2 was higher (59.7% vs 41.4%, P = 0.036) in BGC group compared with non-BGC group. In addition, BGC was associated with successful reperfusion odds ratio, 0.383; 95% confidence interval: 0.174-0.847; P = 0.018). The FP rate of BGC in the distal ICA was higher than that in the proximal ICA (87.5% vs 39.5%, P = 0.000), and the good clinical outcome rate at 90 days in the distal ICA was also higher than that in the proximal ICA (91.7% vs 39.5%, P = 0.000). Conclusion We showed that BGC shortened the procedural time and increased the rate of the successful FP. We recommend that BGC could be considered the preferred technique for endovascular intervention in stroke.

Unique guiding catheter induction technique using aspiration catheter and Amplatz super-stiff guidewire for thrombectomy

Placement of guiding catheters (GCs) in older patients who undergo thrombectomy is often difficult owing to age-related atherosclerotic changes. Herein, we propose a unique technique of balloon guide catheter (BGC) implantation for thrombectomy termed the AC-Amplatz wire method (Aspiration Catheter – Amplatz Super-Stiff Guidewire method). Using the AC-Amplatz wire method, AC was first guided to the C5 portion of the internal carotid artery followed by passing this Amplatz wire through it. Using this novel method, flow control with BGC and good recanalization were achieved. The AC-Amplatz wire method was very effective in GC placement in patients with torturous and atherosclerotic vasculature.

In Vitro Analysis of the Efficacy of Endovascular Thrombectomy Techniques according to the Vascular Tortuosity Using 3D Printed Models.

Achieving complete recanalization with the front-line endovascular thrombectomy device improves the outcome of acute stroke. The aim of this study was to evaluate whether various thrombectomy techniques including contact aspiration, stent retriever thrombectomy, and combination therapy differ in first-pass effect and distal emboli in acute large-vessel occlusion simulated using 3D printed nontortuous and tortuous cerebrovascular anatomy models. 3D printed flow models were manufactured using angiographic data of nontortuous and acutely angulated tortuous vascular anatomy from real patients. Three thrombectomy techniques, contact aspiration, stent retriever, and combined methods, were tested under proximal protection with the balloon-guiding catheter. The first-pass effect and distal emboli rates were analyzed in addition to the thrombectomy-failure mechanisms of the respective techniques. A total of 30 thrombectomy experiments were performed. The overall incidence of first-pass effect in the nontortuous and tortuous anatomy was 80.0% versus 46.7%. The overall incidence of distal emboli in the nontortuous and tortuous anatomy was 26.7% versus 46.7%. The contact aspiration technique showed better first-pass effect (80.0%) and distal emboli rates (20%) in the tortuous model compared with other techniques. The combined technique did not show remarkable superiority of the first-pass effect and distal emboli in either the nontortuous or tortuous anatomy. Shearing off of the thrombus was the main mechanism of thrombectomy failure in the combined group. The tortuous vascular anatomy may worsen the first-pass effect and distal emboli rates. The combined techniques failed to show improvement in outcome due to the shearing-off phenomenon of the thrombus during retrieval.

Double-Balloon Technique Using Optimo Balloon Guiding Catheter for Blood Flow Occlusion During Open Surgical Repair of Femoral Artery Pseudoaneurysm.

Double-Balloon Technique Using Optimo Balloon Guiding Catheter for Blood Flow Occlusion During Open Surgical Repair of Femoral Artery Pseudoaneurysm.

Comparing the Conventional and Balloon-Guided Catheter-Assisted SWIM Technology for the Treatment of Acute Ischemic Stroke.

ObjectiveAcute ischemic stroke is common in elder patients. This study investigates whether using the balloon-guided catheter (BGC) would improve the effect of stent thrombectomy (Solitaire FR With Intracranial Support Catheter for Mechanical Thrombectomy, SWIM) for patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO).MethodThe data of 209 patients with AIS-LVO underwent SWIM were collected retrospectively from January 2017 to June 2021. These patients were divided into two groups based on whether they used of BGC or not. The propensity score matching (PSM) analysis was used to compare the differences in the first pass effect (FPE), successful recanalization, embolus escape rate, symptomatic intracranial hemorrhage (sICH), 90-day clinical favorable outcome, 90-day all-cause mortality, and complications in the patients treated with SWIM combined with balloon-guided catheter or conventional catheter.ResultsAmong the 209 patients, 44 patients were treated with BGC and 165 patients were not. After matching, a total of 111 patients were included. The results showed that there was no statistical difference in FPE (35.1% in non-BGC group compared to 24.3% in BGC group, matched RR, 0.59; 95% CI, 0.24–1.44), successful recanalization (89.2 vs. 91.9%, matched RR, 1.37; 95%CI, 0.34–5.51), embolus escape (6.8 vs. 8.1%, matched RR, 1.22; 95%CI, 0.28–5.40), sICH (8.1 vs. 13.5%; matched RR, 1.77; 95%CI 0.50–6.24), 90-day clinical favorable outcome (48.7 vs. 54.1%, matched RR, 1.11; 95%CI 0.51–2.46), 90-day all-cause mortality (17.6 vs. 21.6%, matched RR, 1.29; 95%CI 0.48–3.47), and the incidence of complications (6.8 vs. 5.4%, matched RR, 0.79 95%CI 0.15–4.27). These results indicate that using SWIM as the first-line treatment for patients with AIS-LVO, there is no statistical significance in FPE, final successful recanalization, distal emboli, sICH, procedural time, 90-day favorable outcome, 90-day mortality, and complications with or without BGC.ConclusionBalloon-guided catheter does not affect the result of using SWIM as the first-line treatment for patients with AIS-LVO. Our results will guide daily practice, with the adoption of the use of a guided catheter without a balloon.

Transfemoral Flow-Reversal for Carotid Artery Stenting with Balloon Guide Catheter: Proof of Concept with Robotic Transcranial Doppler.

In this video, we demonstrate our technique for transfemoral carotid artery stenting (CAS) with flow-reversal through a Walrus balloon guide catheter (BGC) using robotic transcranial Doppler (rTCD) monitoring. Before crossing the plaque for distal filter placement and/or angioplasty, the BGC is inflated and the three-way stopcock opened, allowing back-bleeding. Immediately, the rTCD shows a change in blood-flow direction, indicating flow-reversal, which likely occurs due to a passive pressure gradient between the intracranial compartment and the atmospheric pressure. Then, the filter is placed with reduced risk of displacing plaque fragments, and angioplasty and stenting are performed with dual protection afforded by the BGC and filter. This technique may confer greater safety for CAS. Although in this case rTCD was used for proof of concept, it could also be used as a tool to monitor embolic load during CAS procedures.

EE127 Economic Impact of Balloon Guide Catheter Use with Mechanical Thrombectomy for Acute Ischemic Stroke: A U.S. Payer Perspective Cost Analysis

Balloon guide catheters (BGCs) can be used adjunctively during mechanical thrombectomy (MT) procedures to arrest blood flow and improve reperfusion in the treatment of Acute Ischemic Stroke (AIS). Two recent meta-analyses reported significantly higher rates of 90-day good functional outcomes (modified Rankin Score (mRS) 0-2), in procedures utilizing MT+BGC vs. MT alone. This analysis aims to evaluate the potential economic impact of achieving improved functional outcomes associated with adjunctive BGC use.

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

ObjectiveA 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. MethodsWhen 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. ResultsA 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. ConclusionOur 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.

Safety and efficacy of the SeparGateTM balloon-guiding catheter in neurointerventional surgery: A prospective, multicenter, single-arm clinical trial

ObjectiveTo evaluate the safety and efficacy of the SeparGate™ balloon-guiding catheter (BGC) for blocking flow and delivering devices in neurointerventional surgery. MethodThis prospective multicenter single-arm trial enrolled patients who received BGC adjuvant therapy to provide temporary blood flow arrest of the supra-aortic arch arteries and their branch vessels in interventional therapy. The primary endpoint was immediate procedural success rate in flow arrest, device delivery, and withdrawal. The efficacy endpoints were intraoperative product performance, including rigidity, smoothness, fracture resistance of the catheter wall, catheter push performance, compatibility and radiopaque display, integrity, adhesion thrombus after withdrawal and balloon rupture. The safety endpoints were adverse and serious adverse events associated with the test device and serious adverse events resulting in death or serious health deterioration. ResultA total of 129 patients were included; of them, 128 were analyzed in the full analysis set (FAS) and per protocol set (PPS). Immediate procedural success was achieved in 97.7% of patients with FAS and PPS. The lower bound of the 95% confidence interval was 94.6%, higher than the preset efficacy margin of 94%. Device-related adverse events occurred in 2 (1.6%) cases. One was mild adverse event of vasospasm, which resolved spontaneously. The other was serious adverse event of dissection aggravation, which was treated with stenting angioplasty. No device defects were observed. ConclusionIn neurointerventional surgery, the SeparGate™ BGC can be used to temporarily block the flow of the supra-aortic arch arteries and their branch vessels and guide the interventional device to the target vascular position.

Safety of Sheathless Transradial Balloon Guide Catheter Placement for Acute Stroke Thrombectomy

Transradial access has been described for mechanical thrombectomy in acute stroke, and proximal balloon occlusion has been shown to improve recanalization and outcomes. However, sheathed access requires a larger total catheter diameter at the access site. We aimed to characterize the safety of sheathless transradial balloon guide catheter use in acute stroke intervention. Consecutive patients who underwent sheathless right-sided transradial access for thrombectomy with a balloon guide catheter were identified in a prospectively collected dataset from 2019 to 2021. Demographics, procedure details, and short-term outcomes were collected and reported with descriptive statistics. A total of 48 patients (20 women) with a mean age of 72.3 years were identified. Of patients, 56.3% had occlusions in the left-sided circulation; 35 (72.9%) had M1 occlusions, 7 (14.6%) had M2 occlusions, and 6 (12.5%) had internal carotid artery occlusions. Tissue plasminogen activator was administered to 16 (33.3%) patients. Five (10.4%) patients underwent intraprocedural carotid stenting. The cohort had successful reperfusion after a median of 1 (interquartile range: 1, 2) pass. Median time from access to recanalization was 31 (interquartile range: 25, 53) minutes. A postprocedural Thrombolysis In Cerebral Infarction score of ≥2b was achieved in 46 (95.8%) patients. Five patients had wrist access site hematomas. All hematomas resolved with warm compresses, and no further intervention was required. Sheathless radial access using a balloon guide catheter may be safely performed for acute ischemic stroke with excellent radiographic outcomes. Further investigation is warranted to evaluate the comparative effectiveness of sheathless compared with sheathed transradial balloon guide access.

BOBBY balloon guide catheter thrombectomy in large-vessel occlusion stroke: Initial experience.

Nonrandomized studies have found Balloon Guide Catheter (BGC) use to improve technical and functional outcomes in patients undergoing mechanical thrombectomy (MT). We performed a retrospective analysis on prospectively collected data of consecutive ischemic stroke patients undergoing MT at our institution (December 2020-October 2021). Interventions where BOBBY BGC (BBGC, MicroVentionTM, Aliso Viejo, CA) was used were identified. Baseline demographics and clinico-radiographic characteristics were retrospectively collected and analysed using descriptive statistics. A total of 43 patients received BBGC-MT (male: female = 26:17, median age 72 years [IQR 62-82]). The most common occlusion site was the middle cerebral artery (MCA) (60.4%). Over half (51.2%) received intravenous thrombolytics. The BBGC tracked well over tortuous aortic arches (type II 34.8%, type III 16.3%), with median arteriotomy-to-perfusion time of 29 min (IQR 20-46). Thromboaspiration was used as first-line MT technique in 69.7% cases, with 1 (IQR 1-2) median MT pass achieving modified TICI (thrombolysis in cerebral ischemia) scores of 3 and 2b/3 in 74.4% and 95.3% respectively. Our overall first pass effect (FPE, defined as mTICI 3 after firs-pass) and modified FPE (defined as, mTICI 2b/3 after first-pass) rates were 51.1% and 79.1% respectively, with rates of 92.3% and 100% respectively when stentretriever and thromboaspiration were combined. The median reduction in National Institutes of Health Stroke Scale (NIHSS) was 9 (IQR 4-15, p < 0.0001), with a median 90-day modified Rankin Score (mRS) of 1.5 (IQR 0-2). BOBBY BGC use resulted in a high first-pass effect rate and may contribute towards improved functional outcomes.

Percutaneous debulking strategy for severe nodular calcification in common femoral artery

BackgroundDespite marked progress in endovascular treatment (EVT) techniques and devices, calcified lesions remain one of the toughest obstacles to EVT success. Moreover, because the common femoral artery (CFA) is known as a “non-stenting zone,” endovascular strategies for this area are controversial.Case presentationHere we describe the technical tips for a novel, less invasive, and effective debulking strategy for severe nodular calcification using an endovascular maneuver. This technique was demonstrated in a 73-year-old man with severe calcified stenosis of the CFA. To complete a stent-less strategy for CFA, we conducted aggressive debulking of the nodular calcification, established a bidirectional approach from the radial artery and the superficial femoral artery (SFA), and inserted a balloon-guiding catheter in the SFA. Under distal protection provided by this catheter, we crushed the nodular calcification 43 times using myocardial biopsy forceps. After achieving a volume reduction of nodular calcification through this maneuver, we completed the procedure by inflating a 6-mm drug-coated balloon catheter. Final angiography demonstrated a reduced filling defect of the contrast medium in the CFA and favorable blood flow as far as the ankle. The puncture site on the SFA was closed with a vascular suture assisted by balloon inflation inside the vessel, which allowed the patient to be ambulatory immediately after the procedure without requiring bed rest.ConclusionsSeverely calcified lesions in the CFA are usually difficult to treat using an endovascular strategy, but our novel and less invasive method may become a promising technique for managing these lesions.

Investigation of Current and Super‐Bore 088″ Treatment Strategies of Soft and Stiff Clots at Internal Carotid Artery and Middle Cerebral Artery Occlusion Sites in an In Vitro Thrombectomy Model

Background Various mechanical thrombectomy devices including stent retrievers (STRs), contact aspiration (CA) catheters, and balloon guide catheters (BGCs) are used in both isolation and combination for the treatment of acute ischemic stroke. A new generation of Super‐Bore 088″ aspiration catheters are being trialed clinically. We evaluated the in vitro revascularization performance of current and novel thrombectomy approaches in treating soft (red blood cell–rich) and stiff (fibrin/platelet‐rich) clots at internal carotid artery (ICA) and middle cerebral artery (MCA) occlusion sites. Methods National University of Ireland Galway Research Ethics Committee approved the study. Two human blood clot phenotypes were used to form ICA‐terminus (20‐mm) and MCA–M1 segment (10‐mm) occlusions in an in vitro thrombectomy model. Thrombectomy setups tested were CA: Millipede 088, SOFIA Plus+conventional guide catheter, SOFIA Plus+BGC and C ombination; Millipede 088+STR, SOFIA Plus+BGC+STR, SOFIA Plus+conventional guide catheter+STR. Ten replicates of each experiment were performed totaling 120 tests. Revascularization endpoints were first‐pass effect, final modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3, and procedural‐related distal emboli. Results Millipede 088 CA achieved the highest first‐pass effect rate in ICA‐terminus (60%) and MCA–M1 segment (100%) occlusions and lowest number of procedural‐related distal emboli compared with all other device setups, followed by the combined Millipede 088+STR technique. Amongst the conventional techniques, higher first‐pass effect rates were observed with the combined technique using a BGC (40%) than 6F CA (20%) in ICA‐terminus occlusions whereas the reverse was seen in MCA–M1 segment occlusions, with 6F CA performing better than combined approaches (60% versus 50%). BGCs may provide a revascularization benefit in ICA‐terminus occlusions. Rates of first‐pass effect and final mTICI 2c/3 were better for stiff clots compared with soft clots for all treatment approaches at both occlusion sites. Conclusion Millipede 088 CA was the most effective technique for all clot types and occlusion locations. Across conventional techniques, CA seems to be more effective in MCA–M1 segment occlusions, while the combined technique performed better in ICA occlusions. Clot composition influences the success of each technique.

Combined balloon guide catheter, aspiration catheter, and stent retriever technique versus balloon guide catheter and stent retriever alone technique: a systematic review and meta-analysis

BackgroundThe use of a combination of balloon guide catheter (BGC), aspiration catheter, and stent retriever in acute ischemic stroke thrombectomy has not been shown to be better than a stent...

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.

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.