Balloon Gliding Technique: A novel use of balloon guiding catheters in accessing challenging circulations when treating acute ischemic stroke

Abstract

Background Challenging arterial anatomy delays, or prevents timely endovascular treatment (EVT) of acute ischemic stroke (AIS). We introduce a new technique called ‘Balloon Gliding Technique (BGT)’ to overcome difficult arterial anatomy during EVT of AIS, utilizing flow-assistance to access challenging circulations. Methods Retrospective review of a prospectively collected database of all patients presenting to a single institution with AIS who underwent EVT was performed from January 2021 to June 2021. Patients in whom BGT was performed were assessed. BGT consists of advancing the balloon guide catheter in the cervical carotid artery while its balloon is inflated, and therefore carried by downstream flow. Results Of 51 patients presenting with AIS secondary to large vessel occlusion during the study period, five patients underwent BGT. All five patients had anterior circulation large vessel occlusions. Mean age of the BGT patients was 92.2 years, and all patients were females. A type 3 arch was present in all patients. BGT was performed in all cases following initial failure of conventional techniques to cannulate the target circulation. BGT was successful in achieving distal cervical carotid access in 4 out of the 5 patients in whom BGT was attempted. Successful recanalization (modified treatment in cerebral ischemia 2b-3) was obtained in all cases with no complications. Conclusions Balloon Gliding Technique (BGT) is a safe technique that can safely overcome challenging anatomy during endovascular treatment of acute ischemic stroke. Further studies can assist in demonstrating both its safety and effectiveness.

Neuroimaging of Acute Ischemic Stroke: Multimodal Imaging Approach for Acute Endovascular Therapy

“…50 CTA evaluating the head and neck vessels informs neurointerventionalists who are planning an endovascular procedure on the access of an intracranial target, including bovine or hostile aortic arch and whether radial or femoral arterial access is more appropriate. 51,52 CTA source images are also better to adjudicate ASPECTS in the anterior and posterior circulations. 24 However, radiation exposure, cost, and ionized contrast media are to be considered, especially when CT perfusion (CTP) is added to the protocol.…”

“…The ability to discern carotid pseudo-occlusion from a carotid terminus occlusion versus tandem proximal internal carotid artery (ICA) atherosclerotic occlusion remains a limitation of CTA, even when adjudicated by experienced radiologists [ 50 ]. CTA evaluating the head and neck vessels informs neurointerventionalists who are planning an endovascular procedure on the access of an intracranial target, including bovine or hostile aortic arch and whether radial or femoral arterial access is more appropriate [ 51 , 52 ]. CTA source images are also better to adjudicate ASPECTS in the anterior and posterior circulations [ 24 ].…”

Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

“…Active research is ongoing in patients with MeVO, 55,[112][113][114][115][116][117][118][119] and new EVT techniques are evolving. [120][121][122][123][124][125][126]…”