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Balloon-Assisted Catheterization of Occluded Carotid Artery (BOCA) Technique in Acute Stroke
Farhan Siddiq1, Sachin Bhagavan2, M Fawad Ishfaq2
1Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA.
Insights
The novel Balloon-Assisted Catheterization of Occluded Carotid Artery (BOCA) technique successfully recanalized internal carotid arteries in all patients with tandem occlusions, enabling effective stroke treatment.
Area of Science:
- Interventional Neurology
- Vascular Neurology
- Medical Devices
Background:
- Tandem occlusions of the internal carotid artery (ICA) present significant technical challenges in acute ischemic stroke management.
- Effective revascularization is crucial for improving outcomes in these complex cases.
Purpose of the Study:
- To introduce and evaluate a novel Balloon-Assisted Catheterization of Occluded Carotid Artery (BOCA) technique.
- To assess the safety and efficacy of the BOCA technique for rapid catheterization in tandem ICA occlusions.
Main Methods:
- Retrospective review of 10 patients with tandem carotid occlusion treated between July 2020 and June 2021.
- Detailed analysis of clinical, radiographic, procedural data, BOCA technique specifics, complications, and outcomes.
- The BOCA technique involves direct guide catheterization of the occluded ICA over a partially inflated balloon.
Main Results:
- The BOCA technique achieved ICA recanalization in all 10 patients (100%).
- Successful mechanical thrombectomy of the middle cerebral artery was enabled in all cases.
- High rates of successful reperfusion (Thrombolysis in Cerebral Infarction grade 2b/3) were observed, with a mean groin-to-reperfusion time of 41.4 minutes.
Conclusions:
- The BOCA technique is a viable and effective approach for acute stroke due to tandem ICA occlusion.
- This method facilitates direct guide catheterization, simplifying treatment in challenging tandem occlusion cases.
Background:
Acute ischemic stroke from tandem occlusion of internal carotid artery (ICA) poses a technical challenge to neurointerventionalists.
Objective:
To present a novel balloon-assisted catheterization of occluded carotid artery (BOCA) technique used for rapid and effective catheterization of occluded/critically stenosed ICA in tandem occlusion.
Methods:
A retrospective review of 10 patients with tandem carotid occlusion, treated with BOCA technique for revascularization between July 2020 and June 2021, was performed. Clinical, radiographic, and procedural data; details of BOCA technique; complications; and outcomes were reviewed.
Results:
Of the 10 patients, 8 (80%) had complete occlusion of the cervical ICA and the remaining 2 had high-grade stenosis with poor intracranial flow. The mean age was 63.2 years. The mean presenting NIH Stroke Scale was 13.4. The BOCA technique resulted in recanalization of ICA in all patients and allowed mechanical thrombectomy of middle cerebral artery. Thrombolysis in cerebral infarction grade 2b/3 was achieved in all 10 patients. The mean groin-to-reperfusion time was 41.4 minutes. The mean internal carotid artery stenosis was 99.7% preoperatively and 41.1% postoperatively. Only one patient needed stent at the end of the procedure because of dissection.
Conclusion:
The BOCA technique can be used in distal first approach for acute stroke from tandem ICA occlusion. This technique allows direct guide catheterization of occluded ICA by tracking over a partially inflated balloon.
