The ANTRACK Technique: Employing a Compliant Balloon or Stent Retriever to Advance a Large-Bore Catheter to an Occlusion During Thrombectomy Procedures in Acute Stroke Patients

Abstract

BACKGROUND Stent retrievers and thrombosuction catheters have become the cornerstones of acute stroke therapy. A large-lumen catheter facilitates the passage of different instruments and the application of greater suction force to clots. However, positioning a flexible thrombosuction or intermediate catheter within a tortuous artery is difficult and time-consuming. OBJECTIVE To evaluate the efficacy and safety of the ANchor TRACKing (ANTRACK) technique in achieving distal positioning of a large-lumen catheter in a tortuous cranial artery. We summarize our experience using either a compliant balloon catheter or a stent retriever as an anchor in the distal vessels to facilitate the navigation of a large-lumen catheter into the distal circulation. METHODS Consecutive patients who underwent thrombectomy using the ANTRACK technique were identified. Patient characteristics, procedure details, and outcomes were reviewed from our database. The efficacy and safety of advancing thrombosuction or intermediate catheters to the site of an occlusion were the primary outcome measures. Secondary outcomes included the recanalization result. RESULTS Thirty-nine patients who underwent thrombectomy using the ANTRACK technique were identified; a compliant balloon was used in 32 patients and a stent-retriever was used in 7 patients. The primary outcomes were achieved in all patients. No adverse event was observed. The secondary outcome of recanalization of an occluded artery was achieved in 34 patients (87.2%). CONCLUSION The ANTRACK technique using either a compliant balloon catheter or a stent-retriever is an effective and safe way of passing a large-bore catheter through a tortuous carotid siphon, particularly in cases with atheromatous plaque or ulceration.

Flow diversion in challenging vascular anatomies: the use of low profile stent retrievers for safe and accurate positioning of the microcatheter

“…However, other facilitative, distal anchoring techniquesincluding coil-anchoring and balloonanchoring etc.mostly for endovascular treatment of giant aneurysms, have been reported earlier (Effendi et al, 2016;Oran et al, 2013;Fargen et al, 2013;Snyder et al, 2010). Also, the use of stent retrievers for advancement of large-bore aspiration catheters through tortuous, proximal vessels in the context of intracranial revascularization has been demonstrated previously (Lin et al, 2019;Singh et al, 2015;Mascitelli et al, 2016) and is continuously applied successfully in the clinical routine. Especially the fortifying experience with low profile stent retrievers in stroke treatment (Kurre et al, 2017), more precisely their outstanding distal stability and low risk profile, inspired us to implement them as exchange platforms in technically otherwise hardly controllable scenarios.…”

Early strategy of scepter XC balloon angioplasty and simultaneous Nimodipine infusion for vasospasm following ruptured aneurysm

“…The Scepter XC balloon accommodates a larger 0.014-in. microwire, which provides significant stability to the balloon during navigation of tortuous vessels and distal advancement [13,16]. Furthermore, during the balloon inflation, the 0.014-in.…”

“…The Scepter XC balloon (4x11mm; Microvention, Tustin, CA, USA) is a user-friendly temporary consisting of a dual coaxial lumen attached to a lowinflation pressure-compliant balloon. It has excellent trackability and stability, and the extra-compliant design represents technical advancements in endovascular treatment [13][14][15][16]. Few studies have reported on the feasibility of the Scepter balloon for vasospasm treatment [9,13,14,17].…”

Scepter XC Balloon Angioplasty for Vasospasm Following Ruptured Aneurysm: Single-Center Experience and Results

“…The Scepter XC balloon accommodates a larger 0.014-inch microwire, which provides significant stability to the balloon during navigation of tortuous vessels and distal advancement. [13,16] Furthermore, during the balloon inflation, the 0.014-inch microwire provided increased stability, which resulted in less slippage along the vessel wall relative to the single lumen balloons that have been used previously. Last, we can use a single balloon for multiple segments with repeated inflation and deflation without the need to replace the balloon.…”

“…It has excellent trackability and stability, and the extracompliant design represents technical advancements in endovascular treatment. [13][14][15][16] Few studies have reported on the feasibility of the Scepter balloon for vasospasm treatment. [13,14,17,9] In this study, we detailed the largest single-center case experience of Scepter XC balloon angioplasty and provided an aggressive protocol to treat vasospasm after aneurysm rupture with remarkable clinical outcomes.…”