J Cerebrovasc Endovasc Neurosurg.  2020 Mar;22(1):26-30. 10.7461/jcen.2020.22.1.26.

Spasm, stenosis and shelves:balloon-assisted tracking techniquesin endovascular interventions

• Walker M
• Kim LJ
• Levitt MR
• Ghodke B

• KMID: 2500071
• DOI: http://doi.org/10.7461/jcen.2020.22.1.26

Abstract

The technique of balloon-assisted tracking (BAT) has been demonstrated in transradial cardio-angiographic procedures. Using three commonly encountered clinical scenarios, we outline the technical details of BAT for managing peripheral and cerebral interventions with challenging vascular access. We describe methods used to overcome vasospasm, stenosis and vascular shelves during interventions for acute ischemic stroke, but these issues are not unique to neuroendovascular cases and the techniques can be applied across all endovascular interventions. We present three acute stroke interventions where anatomic challenges were overcome with the use of endovascular BAT. This article describes a novel application for BAT techniques in endovascular interventions to assist with access in peripheral, cervical and intracranial vessels. These methods can also be used to improve access during diagnostic cerebral angiography. BAT is a useful adjunct when navigating catheters through vasospasm, tortuous anatomy, vascular step-offs or intraluminal plaques.

Keyword

Balloon; Tracking, Stroke; Endovascular

Figure

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  Fig. 1 In conjunction with anti-spasm medications, balloon-assistance can help overcome spasm and negotiate catheters through tortuous radial arteries (arrow).

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  Fig. 2 A sub-maximally inflated balloon offers smooth navigation of a guide catheter into the internal carotid artery without disrupting atherosclerotic plaques (arrow) frequently encountered at the carotid bulb.

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  Fig. 3 Balloon-assisted tracking smooths passage across the “shelf” that may occur immediately distal to the cavernous carotid, at the ostium (arrow) of the ophthalmic artery.

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  Fig. 4 The razor-like effect (A) caused by catheter apposition to vessel wall can be alleviated with the use of balloon-assisted tracking (B). This technique can be utilized in tortuous vessels or many other scenarios as described in this technical report.

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