Related Experiment Video
Updated: Oct 7, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Initial Clinical Experience of Repeat Thrombectomy with a Retrieval Stent (RTRS) with Continuous Proximal Flow Arrest
Wen-Huo Chen1, Tingyu Yi1, Yan-Min Wu1
1Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China.
Insights
Repeat thrombectomy with a retrieval stent (RTRS) using a balloon guide catheter (BGC) effectively treated acute intracranial internal carotid artery (ICA) occlusion. This approach achieved high revascularization rates and was safe, potentially reducing distal emboli during stroke treatment.
Area of Science:
- Endovascular therapy
- Neurointerventional surgery
- Cerebrovascular disease
Background:
- Balloon guide catheters (BGCs) are effective in acute ischemic stroke thrombectomy.
- BGCs can become occluded by thrombi, particularly in acute intracranial internal carotid artery (ICA) occlusions.
- A novel approach using repeat thrombectomy with a retrieval stent (RTRS) and continuous proximal flow arrest by BGC was explored.
Purpose of the Study:
- To evaluate the initial experience and outcomes of using RTRS with BGC-mediated proximal flow arrest for acute intracranial ICA occlusion.
- To assess the safety and efficacy of this technique in achieving successful revascularization and favorable clinical outcomes.
Main Methods:
- Retrospective analysis of clinical and procedural data from 32 consecutive patients with acute intracranial ICA occlusion treated with RTRS and BGC.
- Data collected included NIHSS and mRS scores, eTICI scores, procedural times, and complications.
- Continuous proximal flow arrest was maintained using the BGC during stent retriever deployment and retrieval.
Main Results:
- Successful revascularization was achieved in all 32 patients.
- Extended treatment in Cerebral Infarction (eTICI) 2c or better recanalization was achieved in 93.8% of patients.
- No procedure-related complications or symptomatic intracranial hemorrhage occurred; distal emboli occurred in 6.3% without anterior cerebral artery involvement.
Conclusions:
- RTRS with proximal flow arrest by BGC is an effective and safe treatment for intracranial ICA occlusion.
- The technique demonstrates good clinical and angiographic outcomes.
- This method may decrease the incidence of distal emboli during stent retriever thrombectomy for acute stroke.
Background:
Balloon guide catheters (BGCs) have good performance in terms of radiological outcomes in acute ischemic thrombectomy. It is not uncommon for BGCs to be blocked by thrombi, especially in cases with acute intracranial internal carotid artery (ICA) occlusion. Our initial experience using repeat thrombectomy with a retrieval stent (RTRS) with continuous proximal flow arrest by BGC for acute intracranial ICA occlusion is presented.
Methods:
In patients with acute intracranial ICA occlusion treated with RTRS, clinical data, including the National Institutes of Health Stroke Scale (NIHSS) score at admission and modified Rankin Scale (mRS) score at 90 days, and procedural data, including the Extended treatment in Cerebral Infarction (eTICI) score, procedural time, and complications, were analyzed.
Results:
Thirty-two consecutive patients (12 men (37.5%); mean age: 73 years) were treated with RTRS using a BGC. The median NIHSS score was 19. The median puncture-to-reperfusion time was 46 minutes (range: 22-142 minutes). All patients were successfully revascularized; eTICI 2c or better recanalization was achieved in 30 (93.8%) patients. No procedure-related complications or symptomatic intracranial hemorrhage occurred. Two cases (6.3%) had distal emboli, but none had emboli to the anterior cerebral artery. Fourteen patients (43.8%) achieved a good outcome with an mRS score of 0-2 at 90 days, and 8 patients (25.0%) died.
Conclusions:
In patients with intracranial ICA occlusion, RTRS with proximal flow arrest by BGC is effective and safe, achieving good clinical and angiographic outcomes. This method may reduce the incidence of distal emboli in thrombectomy with stent retrievers.
