J Korean Neurosurg Soc.  2016 Jul;59(4):379-384. 10.3340/jkns.2016.59.4.379.

Efficacy of Proximal Aspiration Thrombectomy for Using Balloon-Tipped Guide Catheter in Acute Intracranial Internal Carotid Artery Occlusion

• Kim YW
• Kang DH
• Hwang YH
• Park J
• Kim YS

• KMID: 2315974
• DOI: http://doi.org/10.3340/jkns.2016.59.4.379

Abstract

OBJECTIVE
Mechanical thrombectomy (MT) for acute intracranial internal carotid artery (ICA) occlusion is often complicated by difficult revascularization and non-involved territory embolization possibly related with larger clot-burden. This study aims to evaluate the efficacy of proximal aspiration thrombectomy (PAT) using a balloon-tipped guide catheter for clot-burden reduction in such cases with period-to-period analysis (period 1 : standard MT without PAT; period 2 : PAT first, then standard MT for the remaining occlusion).
METHODS
Eighty-six patients who underwent MT for acute intracranial ICA occlusion were included in this analysis from the prospectively maintained stroke registry (33 patients in period 1 and 53 in period 2). In period 2, 'responder' was defined as a case where some amount of clot was retrieved by PAT and the following angiography showed partial or full recanalization.
RESULTS
Fifteen of fifty-three patients in period 2 (28.3%) were 'responders' to PAT. There was a significantly higher incidence of atrial fibrillation in the 'responder' subgroup. Period 2 showed a significantly shorter puncture-to-reperfusion time (94.5 minutes vs. 56.0 minutes; p=0.002), a significantly higher Thrombolysis in Cerebral Infarction of 2b-3 reperfusion (45.5% vs. 73.6%; p=0.009), but only a trend for better 3-month favorable outcome (mRS 0-2; 36.4% vs. 54.7%; p=0.097). There was no increase in the incidence of procedure-related complications or intracranial hemorrhage in period 2.
CONCLUSION
A strategy of PAT before standard MT may result in shorter puncture-to-reperfusion time and better angiographic outcome than a strategy of standard MT for acute intracranial ICA occlusion.

Keyword

Acute ischemic stroke; Balloon-tipped guide catheter; Internal carotid artery; Mechanical thrombectomy; Proximal aspiration thrombectomy

MeSH Terms

Angiography
Atrial Fibrillation
Carotid Artery, Internal*
Catheters*
Cerebral Infarction
Humans
Incidence
Intracranial Hemorrhages
Prospective Studies
Reperfusion
Stroke
Thrombectomy*

Figure

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  Fig. 1 Illustration of the proximal aspiration thrombectomy in an intracranial internal carotid artery occlusion.

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  Fig. 2 This shows four typical case examples of proximal aspiration thrombectomy (PAT) for clot-burden reduction using balloon-tipped guiding catheter (BGC) in acute intracranial internal carotid artery (ICA)occlusion. The cases in the first and second row are 'responders' to the technique, which indicates that the following angiographies are showing partial or full recanalization after retrieval of some clots during the procedure. And the cases in the third and fourth row are 'non-responders' to the technique, which indicates that the following angiographies are showing still occluded ICA after a few attempts of the PAT procedure.

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