J Cerebrovasc Endovasc Neurosurg.  2012 Sep;14(3):141-147. 10.7461/jcen.2012.14.3.141.

The Usefulness of Compliant Balloon for Recanalization of Acute Ischemic Stroke

• Kang MS
• Kim JH
• Kang HI
• Moon BG
• Lee SJ
• Kim JS

• KMID: 1808447
• DOI: http://doi.org/10.7461/jcen.2012.14.3.141

Abstract

OBJECTIVE
We report on our experience using a compliant balloon for treatment of thrombi resistant to simple mechanical thrombolysis.
METHODS
We conducted a retrospective investigation of 46 consecutive acute ischemic stroke patients who were treated by intraarterial thrombolysis (IAT) between January 2008 and July 2010. We compared IAT results between the balloon group (BG) and the simple mechanical thrombolysis (with microcatheter and microguidewire) group (SG). The Thrombolysis in Myocardial Infarction (TIMI) grading system was used for grading of the degrees of vessel recanalization. In addition, a modified Thrombolysis in Cerebral Infarction (TICI) score was used for post-IAT TIMI grade 2 patients. Modified Rankin Scale scores were used at three months for assessment of clinical outcomes.
RESULTS
Twenty of the 46 subjects were treated with a compliant balloon. The mean initial National Institutes of Health Stroke Scale score was 15.1 in the BG and 14 in the SG. The mean time from symptom onset to initiation of IAT was 225 minutes in the BG and 177 in the SG (p = 0.004). The overall rate of successful recanalization (TIMI grade 2 or 3) was 85% in the BG and 73% in the SG (p = 0.476). In the TIMI grade 2 group, modified TICI 2b was 90% in the BG and 16% in the SG (p = 0.001). Postprocedure intraparenchymal hemorrhage occurred in two subjects in the BG and 10 subjects in the SG (p = 0.029). No significant difference in clinical outcomes was observed between the BG and SG (p = 0.347).
CONCLUSIONS
The compliant balloon showed high potential for recanalization following acute ischemic stroke, especially when simple mechanical thrombolysis had failed.

Keyword

Balloon; Thrombolysis; Recanalization

MeSH Terms

Cerebral Infarction
Glycosaminoglycans
Hemorrhage
Humans
Mechanical Thrombolysis
Myocardial Infarction
National Institutes of Health (U.S.)
Retrospective Studies
Stroke
Glycosaminoglycans

Figure

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  Fig. 1 A computed tomographic scan reveals no low density lesion in the left cerebral hemisphere (A). An angiography shows occlusion of the proximal portion of the left middle cerebral artery (B) and complete recanalization of the occluded vessel after balloon thrombolysis (C). Follow-up magnetic resonance angiography one week later demonstrates complete recanalization of the left middle cerebral artery (D).

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