ABGCEPD for acute symptomatic isolated cervical internal carotid artery occlusion to improve reperfusion and reduce...

Area of Science:

• Neurology
• Vascular Surgery
• Interventional Radiology

Background:

• Optimal endovascular treatment strategies for acute symptomatic isolated cervical internal carotid artery occlusion (sICAO) are not well-defined due to anatomical challenges and embolization risks.
• Distal embolization poses a significant threat during endovascular procedures for sICAO.

Purpose of the Study:

• To evaluate the safety, effectiveness, and outcomes of a novel Aspiration-Based Dual-Protection Strategy Under Proximal Balloon Occlusion and Distal Embolic Protection Device (ABGCEPD) for treating acute sICAO.
• To assess the feasibility of ABGCEPD in managing moderate-to-severe strokes caused by sICAO.

Main Methods:

• A retrospective study involving 65 patients with acute moderate-to-severe stroke due to sICAO treated with ABGCEPD between January 2016 and December 2023.
• Primary outcome: successful reperfusion (modified Thrombolysis in Cerebral Infarction score ≥ 2b).
• Secondary outcomes: 90-day modified Rankin Scale (mRS) score (0-2 for good outcome), mortality, symptomatic intracranial hemorrhage (sICH), and embolization to new territories (ENT).

Main Results:

• Successful reperfusion was achieved in 92.9% of patients (modified Thrombolysis in Cerebral Infarction score ≥ 2b).
• A good clinical outcome (90-day mRS 0-2) was observed in 60% of patients.
• Low rates of secondary outcomes: sICH (10.7%), mortality (7.1%), and ENT (7.0%).

Conclusions:

• The Aspiration-Based Dual-Protection Strategy Under Proximal Balloon Occlusion and Distal Embolic Protection Device (ABGCEPD) is a feasible, safe, and effective endovascular method for acute sICAO.
• ABGCEPD may reduce the incidence of distal embolization during endovascular treatment of sICAO.