J Korean Neurosurg Soc.  2019 Jul;62(4):405-413. 10.3340/jkns.2019.0007.

Efficacy of Combining Proximal Balloon Guiding Catheter and Distal Access Catheter in Thrombectomy with Stent Retriever for Anterior Circulation Ischemic Stroke

• Kim SH
• Choi JH
• Kang MJ
• Cha JK
• Kim DH
• Nah HW
• Park HS
• Kim SH
• Huh JT

• KMID: 2463671
• DOI: http://doi.org/10.3340/jkns.2019.0007

Abstract

OBJECTIVE
We evaluated efficacy of combining proximal balloon guiding catheter (antegrade flow arrest) and distal access catheter (aspiration at the site of occlusion) in thrombectomy for anterior circulation ischemic stroke.
METHODS
We retrospectively analyzed 116 patients who underwent mechanical thrombectomy with stent retriever. The patients were divided by the techniques adopted, the combined technique (proximal balloon guiding catheter and large bore distal access catheter) group (n=57, 49.1%) and the conventional (guiding catheter with stent retriever) technique group (n=59, 50.9%). We evaluated baseline characteristics (epidemiologic data, clinical and imaging characteristics) and procedure details (the number of retrieval attempts, procedure time), as well as angiographic (thrombolysis in cerebral infarction (TICI) score, distal thrombus migration) and clinical outcome (National Institutes of Health Stroke Scale at discharge, modified Rankin Scale [mRS] at 3 months) of them.
RESULTS
The number of retrieval attempts was lower (p=0.002) and the first-pass successful reperfusion rate was higher (56.1% vs. 28.8%; p=0.003) in the combined technique group. And the rate of final result of TICI score 3 was higher (68.4% vs. 28.8%; p<0.01) and distal thrombus migration rate was also lower (15.8% vs. 40.7%; p=0.021) in the combined technique group. Early strong neurologic improvement (improvement of National Institutes of Health Stroke Scale ≥11 or National Institutes of Health Stroke Scale ≤1 at discharge) rate (57.9% vs. 36.2%; p=0.02) and favorable clinical outcome (mRS at 3 months ≤2) rate (59.6% vs. 33.9%; p=0.005) were also better in the combined technique group.
CONCLUSION
The combined technique needs lesser attempts, decreases distal migration, increases TICI 3 reperfusion and achieves better clinical outcomes.

Keyword

Stroke; Brain ischemia; Thrombectomy; Stents

MeSH Terms

Academies and Institutes
Brain Ischemia
Catheters*
Cerebral Infarction
Humans
National Institutes of Health (U.S.)
Reperfusion
Retrospective Studies
Stents*
Stroke*
Thrombectomy*
Thrombosis

Figure

• 

  Fig. 1. Angiograms of “the combined technique” for left proximal M1 occlusion. A : Pre-treatment angiogram (antero-posterior view) shows the occlusion of left proximal M1 segment. B : A Solitaire stent retriever was deployed within the left M1 segment. Arrow indicates the distal marker of Solitaire stent. Arrowhead points the location of the large bore distal access catheter for aspiration. C : The balloon catheter was inflated for proximal flow arrest (lateral view). Arrow indicates the distal marker of Solitaire stent. Arrowhead indicates the location of the large bore distal access catheter for aspiration. D : After first retrieval under simultaneous distal aspiration with proximal flow arrest, angiogram shows complete recanalization without distal thrombus migration (thrombolysis in cerebral infarction 3). E and F : Photographs shows retrieved clot fragment within Solitaire stent retriever (E) and aspirated clot within the distal access catheter (F).

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  Fig. 2. Distribution of the number of retrieval attempts in the combined technique group and the conventional technique group. The percentage of patients is shown in each cell.

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  Fig. 3. Distribution of the mRS at 3 months in the combined technique group and the conventional technique group. The percentage of patients is shown in each cell. mRS : modified Rankin Scale.

Reference

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