Initial clinical experience using the two-stage aspiration technique (TSAT) with proximal flow arrest by a balloon guiding catheter for acute ischemic stroke of the anterior circulation

Matsumoto, Hiroyuki; Nishiyama, Hirokazu; Tetsuo, Yoshiaki; Takemoto, Hideki; Nakao, Naoyuki

doi:10.1136/neurintsurg-2016-012787

Cited by 17 publications

(10 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Intracranial aspiration with proximal flow arrest by a balloon guiding catheter may also reduce the rate of embolic complications. 18 Other safety parameters were similar between the aspiration and stent retriever groups in our study.…”

Section: Discussionsupporting

confidence: 69%

Mechanical thrombectomy in basilar artery occlusion: influence of reperfusion on clinical outcome and impact of the first-line strategy (ADAPT vs stent retriever)

Gory

Mazighi

Blanc

et al. 2018

Journal of Neurosurgery

131

View full text Add to dashboard Cite

OBJECTIVE Several randomized trials have been focused on patients with anterior circulation stroke, whereas few data on posterior circulation stroke are available. Thus, new mechanical thrombectomy (MT) strategies, including a direct-aspiration first-pass technique (ADAPT), remain to be evaluated in basilar artery occlusion (BAO) patients. The authors here assessed the influence of reperfusion on outcome in BAO patients and examined whether ADAPT improves the reperfusion rate compared with stent retriever devices. METHODS Three comprehensive stroke centers prospectively collected individual data from BAO patients treated with MT. Baseline characteristics as well as radiographic and clinical outcomes were compared between the 2 MT strategies. The primary outcome measure was the rate of successful reperfusion, defined as a modified Thrombolysis in Cerebral Infarction (mTICI) grade of 2b-3. Favorable outcome was defined as a 90-day modified Rankin Scale score of 0-2. RESULTS Among the 100 adult patients included in the study, 46 were treated with first-line ADAPT (median age 61 years, IQR 53-71 years; stent-retriever rescue therapy was secondarily used in 12 [26.1%]) and 54 were treated with a primary stent retriever (median age 67 years, IQR 53-78 years). There was no difference in baseline characteristics between the 2 treatment groups, except for the rate of diabetes (19.6% vs 5.7%, respectively, p = 0.035). Successful reperfusion was achieved in 79% of the overall study sample. Overall, the rate of favorable outcome was 36.8% and 90-day all-cause mortality was 44.2%. Successful reperfusion positively impacted favorable outcome (OR 4.57, 95% CI 1.24-16.87, p = 0.023). A nonsignificant trend toward a higher successful reperfusion rate (unadjusted OR 2.56, 95% CI 0.90-7.29, p = 0.071) and a significantly higher rate of complete reperfusion (mTICI grade 3; unadjusted OR 2.59, 95% CI 1.14-5.86, p = 0.021) was found in the ADAPT group. The procedure duration was also significantly lower in the ADAPT group (median 45 minutes, IQR 34 to 62 minutes vs 56 minutes, IQR 40 to 90 minutes; p = 0.05), as was the rate of periprocedural complications (4.3% vs 25.9%, p = 0.003). Symptomatic intracranial hemorrhage (0.0% vs 4.0%, p = 0.51) and 90-day all-cause mortality (46.7% vs 42.0%, p = 0.65) were similar in the 2 groups. CONCLUSIONS Among BAO patients, successful reperfusion is a strong predictor of a 90-day favorable outcome, and the choice of ADAPT as the first-line strategy achieves a significantly higher rate of complete reperfusion with a shorter procedure duration.

show abstract

Section: Discussionsupporting

confidence: 69%

Mechanical thrombectomy in basilar artery occlusion: influence of reperfusion on clinical outcome and impact of the first-line strategy (ADAPT vs stent retriever)

Gory

Mazighi

Blanc

et al. 2018

Journal of Neurosurgery

131

View full text Add to dashboard Cite

show abstract

“…There is one concern about cerebral ischemia caused by continuous proximal blood flow arrest using balloon occlusion, which has also been reported with the TSAT technique [21]. However, we only adopt this technique in patients with intracranial ICA occlusion, so we do not need to worry about this problem because the vessel is initially occluded and there is no blood supply downstream territory.…”

Section: Discussionmentioning

confidence: 96%

“…For example, the use of distal access catheters in association with SR, which is common in clinical practice, can decrease the distal emboli incidence from 5% to 11% [19]. The use of BGCs can also decrease the incidence of distal emboli [20,21]. Regarding intracranial ICA occlusion, the incidence of distal emboli is as high as 75% in patients who underwent MT with conventional guide catheters [20], but the incidence decreases to 0% when MT is combined with BGCs [20].…”

Section: Discussionmentioning

confidence: 99%

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

Chen

Pan

et al. 2021

Behavioural Neurology

View full text Add to dashboard Cite

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.

show abstract

“…[1][2][3][4][5] Several methods have been investigated to increase the effects of recanalization therapy, and proximal blood flow control using a balloon-guiding catheter (BGC) was found to increase the recanalization rate, shorten the procedure time, and prevent embolism of new territory (ENT), being an effective method to improve the outcome. [6][7][8] In addition, it was recently reported that BGC located at a site distal to the main trunk of the internal carotid artery (ICA) improves the recanalization rate and shortens the procedure time compared with proximal placement. 9) At our facility, the combination of 100-cm BGC and 40-cm long sheath has been used as a standard device to reliably place the BGC into a site distal to the ICA after treating a patient in whom a BGC was unable to be placed in the ICA due to an insufficient length, resulting in unsuccessful thrombectomy in 2018.…”

Section: Introductionmentioning

confidence: 99%

Combined Technique Thrombectomy with a Long Balloon-Guiding Catheter and Long Sheath Aids in Rapid and Stable Recanalization in Patients with Anterior Circulation Acute Ischemic Stroke

Miki

Aizawa

Fujii

et al. 2021

JNET

View full text Add to dashboard Cite

The purpose of this study was to evaluate the combination of a 100-cm long balloon-guiding catheter (BGC) and 40-cm long sheath in patients treated by mechanical thrombectomy for anterior circulation acute ischemic stroke. Methods: The subjects were 77 consecutive patients treated by endovascular recanalization for anterior circulation occlusion from January 2011. After February 2018, 24 patients were treated by mechanical thrombectomy using a long BGC and long sheath (L-BGC group), and were compared with 53 patients treated before January 2018 using a normal BGC and sheath (S-BGC group). The baseline angiographical/clinical characteristics, main procedures, BGC insertion time, internal carotid artery (ICA) cartelization rate, recanalization rate, and clinical outcome were compared between L-BGC and S-BGC groups. Results: There was no significant difference in angiographical/clinical characteristics except for intravenous thrombolysis with recombinant tissue plasminogen activator (IVrtPA) treatment. In all, 22 patients were treated by combined technique (CoT) thrombectomy in the L-BGC group. The BGC insertion time was significantly shorter in the L-BGC group than in the S-BGC group (19 vs 13 minutes), and ICA catheterization of BGC was successful in the L-BGC group, whereas there were seven failures in the S-BGC group (100% vs 84%). The puncture-to-recanalization (PtoR) time was significantly shorter in the L-BGC group (90 vs 44 minutes). The successful recanalization (SR) rate was higher in the L-BGC group (96% vs 72%). Good outcomes (mRS 0-2) slightly increased in the L-BGC group (64% vs 49%). In the multivariable analysis, only CoT thrombectomy was associated with PtoR and SR. Conclusion: The combination of a long BGC and long sheath results in rapid and stable BGC insertion to the ICA. CoT thrombectomy with these devices may be useful for SR and reducing the PtoR in anterior circulation mechanical thrombectomy. Keywords▶ balloon-guiding catheter, acute ischemic stroke, thrombectomy This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

show abstract

Initial clinical experience using the two-stage aspiration technique (TSAT) with proximal flow arrest by a balloon guiding catheter for acute ischemic stroke of the anterior circulation

Abstract: TSAT with proximal flow arrest by a balloon guiding catheter is an effective and safe method to achieve good clinical and angiographic outcomes. This method may reduce ENT in the direct aspiration first-pass thrombectomy (ADAPT) technique.

Cited by 17 publications

References 26 publications

Mechanical thrombectomy in basilar artery occlusion: influence of reperfusion on clinical outcome and impact of the first-line strategy (ADAPT vs stent retriever)

Mechanical thrombectomy in basilar artery occlusion: influence of reperfusion on clinical outcome and impact of the first-line strategy (ADAPT vs stent retriever)

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

Combined Technique Thrombectomy with a Long Balloon-Guiding Catheter and Long Sheath Aids in Rapid and Stable Recanalization in Patients with Anterior Circulation Acute Ischemic Stroke

Contact Info

Product

Resources

About