Acute Ischemic Stroke due to Common Carotid Ostial Disease with Tandem Intracranial Occlusions Treated with Thrombectomy and Staged Retrograde Stenting

Amuluru, Krishna; Al‐Mufti, Fawaz; Romero, Charles E.

doi:10.1159/000490584

Cited by 4 publications

(4 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[8,9] In addition, if the stent is released, dual antiplatelet therapy may be required, thereby increasing the risk of intracranial hemorrhage. [10] As a result of the anatomical characteristics of the posterior circulatory vessels, surgical paths can be divided into dirty-road pathways and clean-road pathways. Current research on optimal surgical approaches has not conclusively weighed in favor of one over the other.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Dilator-Dotter technique can successfully treat tandem lesions of posterior circulation

Han,

Ma,

Zhao

et al. 2024

Medicine

View full text Add to dashboard Cite

In this study, we applied the Dilator-Dotter technique, a catheter-based angioplasty, to cross through severely stenotic or occluded vertebral arteries during mechanical thrombectomy, and we explored its efficacy and safety in treating tandem lesions of posterior circulation. We performed a retrospective analysis of patients with acute stroke caused by tandem lesions of posterior circulation treated with the Dilator-Dotter technique and thrombectomy between July 2017 and December 2021. In addition to collecting clinical, radiographic, and procedural data from patient records, we also collected information about surgical complications and outcome. We enrolled 9 patients for this study. In all cases, the vertebral artery (VA) on the affected side was crossed through via the Dilator-Dotter technique, and mechanical thrombectomy was successfully performed. The average time from groin puncture to revascularization (TICI 2B–3) was 26 minutes (range 16–50 minutes). Eight patients (89%) achieved complete recanalization with TICI 3, and only 1 patient suffered from thrombus escape to the posterior cerebral artery. Eight patients underwent VA stenting, while the remaining patient was excluded from this procedure because a postoperative brain CT scan recorded obvious staining of the contrast medium within the infarcted area. Five patients had modified Rankin Scale scores ≤ 3 at the 3-month follow-up examination, and 2 patients died due to postoperative cerebral hemorrhage and severe ischemia. The Dilator-Dotter technique may represent a safe and effective treatment for tandem lesions of posterior circulation. Using this method, the lesions can be rapidly recanalized and treated.

show abstract

Section: Discussionmentioning

confidence: 99%

“…[8,9] In addition, if the stent is released, dual antiplatelet therapy may be required, thereby increasing the risk of intracranial hemorrhage. [10]…”

Section: Discussionmentioning

confidence: 99%

The Dilator-Dotter technique can successfully treat tandem lesions of posterior circulation

Han,

Ma,

Zhao

et al. 2024

Medicine

View full text Add to dashboard Cite

show abstract

“…14 On the other hand, advantages of proximal recanalization first include subsequent access to the intracranial LVO with larger guide catheters, collateral restoration, theoretic reduction of further embolization, and, in some cases, spontaneous distal recanalization. 2,3,[13][14][15][16] Controversy also exists regarding balloon angioplasty alone versus carotid stent placement for the treatment of the proximal lesion. Both techniques have associated risks, including distal emboli propagation and intracerebral hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

The Dilator-Dotter Technique: A Modified Method of Rapid Internal Carotid Artery Revascularization in Acute Ischemic Stroke

Amuluru

Sahlein

Al‐Mufti

et al. 2020

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: Acute ischemic stroke due to tandem occlusive lesions involves high-grade ICA stenosis or occlusion with a distal intracranial occlusion. Several approaches and devices exist in the treatment of tandem occlusions; however, a consensus on the optimal technique does not exist. The Dotter technique is a method of catheter-based angioplasty to recanalize cervical ICA occlusions. We present a modified dilator-Dotter technique, which involves a polyethylene, tapered inner dilator to initially cross the occlusion, followed by guide catheterization and subsequent intracranial thrombectomy. The purpose of this study was to examine the safety and efficacy of this dilator-Dotter technique. MATERIALS AND METHODS:We performed a retrospective review of patients with acute stroke due to tandem ICA intracranial occlusions, treated with our dilator-Dotter technique and thrombectomy between June 2018 and December 2019. We examined clinical, radiographic, and procedural data, as well as complications and outcomes.RESULTS: Thirty-two patients were included. In 100% of cases, the dilator-Dotter technique resulted in ICA recanalization allowing successful thrombectomy. TICI 2b-3 revascularization was obtained in 31 patients (96%), within an average time of 25 minutes. The average preprocedural ICA stenosis was 98%, including 23 patients (72%) with complete occlusion. Following the dilator-Dotter technique, average ICA stenosis improved to 59%. There were no instances of death, iatrogenic dissection, emboli to new territory, or symptomatic intracranial hemorrhage. CONCLUSIONS:The dilator-Dotter technique may be a safe and effective modification of the traditional Dotter technique in allowing rapid ICA recanalization in cases of acute ischemic stroke due to tandem occlusions. ABBREVIATIONS: ADAPT ¼ direct aspiration first-pass technique; AIS ¼ acute ischemic stroke; ICH ¼ intracranial hemorrhage; LVO ¼ large-vessel occlusion; sICH ¼ symptomatic intracranial hemorrhage

show abstract

“…Advocates of DTP approach prefer quicker restoration of intracranial cerebral perfusion followed by emergent or staged cervical ICA stenting. 12,13 Higher risk of poststenting ICH and resulting poor prognosis is cited as typical deterrent to up-front stenting. [14][15][16][17][18] Safe, effective, and expedient catheterization of occluded cervical ICA with a guide catheter is a key step for a successful DTP approach.…”

mentioning

confidence: 99%

Balloon-Assisted Catheterization of Occluded Carotid Artery (BOCA) Technique in Acute Stroke

Siddiq

Bhagavan

Ishfaq

et al. 2023

Operative Neurosurgery

View full text Add to dashboard Cite

BACKGROUND: Acute ischemic stroke from tandem occlusion of internal carotid artery (ICA) poses a technical challenge to neurointerventionalists. OBJECTIVE: To present a novel balloon-assisted catheterization of occluded carotid artery (BOCA) technique used for rapid and effective catheterization of occluded/critically stenosed ICA in tandem occlusion. METHODS: A retrospective review of 10 patients with tandem carotid occlusion, treated with BOCA technique for revascularization between July 2020 and June 2021, was performed. Clinical, radiographic, and procedural data; details of BOCA technique; complications; and outcomes were reviewed. RESULTS: Of the 10 patients, 8 (80%) had complete occlusion of the cervical ICA and the remaining 2 had high-grade stenosis with poor intracranial flow. The mean age was 63.2 years. The mean presenting NIH Stroke Scale was 13.4. The BOCA technique resulted in recanalization of ICA in all patients and allowed mechanical thrombectomy of middle cerebral artery. Thrombolysis in cerebral infarction grade 2b/3 was achieved in all 10 patients. The mean groin-to-reperfusion time was 41.4 minutes. The mean internal carotid artery stenosis was 99.7% preoperatively and 41.1% postoperatively. Only one patient needed stent at the end of the procedure because of dissection. CONCLUSION: The BOCA technique can be used in distal first approach for acute stroke from tandem ICA occlusion. This technique allows direct guide catheterization of occluded ICA by tracking over a partially inflated balloon.

show abstract

Acute Ischemic Stroke due to Common Carotid Ostial Disease with Tandem Intracranial Occlusions Treated with Thrombectomy and Staged Retrograde Stenting

Cited by 4 publications

References 32 publications

The Dilator-Dotter technique can successfully treat tandem lesions of posterior circulation

The Dilator-Dotter technique can successfully treat tandem lesions of posterior circulation

The Dilator-Dotter Technique: A Modified Method of Rapid Internal Carotid Artery Revascularization in Acute Ischemic Stroke

Balloon-Assisted Catheterization of Occluded Carotid Artery (BOCA) Technique in Acute Stroke

Contact Info

Product

Resources

About