Modified carotid artery balloon angioplasty technique for challenging tandem occlusions in acute stroke
Marco A Marangoni1, Behzad Taeb2, David Volders3
1Department of Radiology, Division of Neuroradiology, Halifax Infirmary, Dalhousie University, Halifax, NS, Canada.
Insights
A modified carotid angioplasty technique successfully advances guiding catheters through carotid stenosis in acute ischemic stroke patients. This facilitates faster endovascular thrombectomy for tandem occlusions, improving patient outcomes.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Tandem occlusions in acute ischemic stroke complicate endovascular thrombectomy.
- Carotid stenosis often impedes guiding catheter advancement, delaying treatment and worsening outcomes.
Purpose of the Study:
- To present a modified carotid angioplasty technique for facilitating guiding catheter passage through carotid stenosis.
- To improve revascularization times and outcomes in acute ischemic stroke with tandem occlusions.
Main Methods:
- A novel angioplasty technique involving partial balloon inflation within the distal guiding catheter and carotid stenosis.
- This method creates momentum to advance the guiding catheter past the stenosis.
Main Results:
- Successful advancement of the guiding catheter through challenging carotid stenosis.
- Reduced recanalization times compared to standard approaches, enabling faster intracranial treatment.
Conclusions:
- The modified carotid angioplasty technique offers a solution for navigating carotid stenosis during endovascular thrombectomy.
- This approach can expedite treatment for tandem occlusions, potentially improving patient prognosis.
Abstract:
Tandem occlusion in the setting of acute ischemic stroke presents a challenge for endovascular thrombectomy, leading to delayed revascularization with associated poor prognosis and unfavorable outcomes. Simple angioplasty of the carotid stenosis does not always allow the guiding catheter to advance past the stenosis. We present a modified carotid angioplasty technique in which the guiding catheter can successfully be advanced through the carotid stenosis. This allows for faster recanalization and treatment of the intracranial occlusion, knowing that longer procedure times lead to worse outcome. During the modified angioplasty technique, the angioplasty balloon is positioned and inflated partially within the distal guiding catheter and partially within the carotid stenosis. This technique creates momentum for the guiding catheter to advance past the stenosis before it recollapses. Similar techniques have been described before to cross carotid stenosis with an aspiration catheter, and using a diagnostic catheter with a 0.035" wire, using the Dotter technique. However, with this technique it is the guide catheter which can be positioned beyond the proximal carotid stenosis, allowing for access to the intracranial circulation to perform as many thrombectomy passes as required. This allows for faster access to the occluded vessel, without the need for initial stenting, reducing the recanalization times in challenging tandem occlusion cases.
