Purpose

Tandem occlusive lesions are responsible for up to 20% of acute ischemic stroke cases and are associated with poor prognosis if complete recanalization cannot be achieved. Endovascular recanalization might be challenging due to difficulties in the safe passage of the occluded plaque at the origin of the internal carotid artery (ICA). The balloon-assisted tracking technique (BAT), where a partially deflated balloon is exposed out of the catheter tip to facilitate its passage through stenosed or spastic arterial segments was introduced by interventional cardiologists and the applicability of the technique has been recently proposed in the field of neurointervention as well. Here we describe our experience using the BAT technique in the endovascular recanalization of tandem occlusive lesions.

Methods

Procedures were performed from June 2013 to December 2020 in a single center. Baseline clinical and imaging data, procedural and follow-up details and clinical outcomes were retrospectively collected.

Results

In this study 107 patients, median age 66 years, median admission NIHSS 14 and median ASPECTS 8 were included. Successful recanalization of the ICA using the BAT technique was achieved in 100 (93%) and successful intracranial revascularization in 88 (82%) patients. There were no complications attributable to the BAT technique. Intraprocedural complications occurred in 9 (8%) patients. Emergent stenting was performed in 40 (37%) at the end of the procedure. Postprocedural adverse events (intracerebral hemorrhage [ICH], malignant infarction) occurred in 6 (5%) patients. Good clinical outcome at 3 months (modified Rankin scale [mRS] 0–2) was 54 (50%) and mortality 26 (24%). Delayed stent placement during follow-up occurred in 21 cases.

Conclusion

Application of BAT technique in tandem occlusions appears feasible, safe, and efficient. Further evaluation of this technique is awaited.

中文翻译：

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使用球囊辅助跟踪技术对串联颈内动脉闭塞进行血管内再通。

目的

高达 20% 的急性缺血性卒中病例是由串联闭塞性病变引起的，如果无法实现完全再通，则与预后不良有关。由于颈内动脉 (ICA) 起源处的闭塞斑块难以安全通过，血管内再通可能具有挑战性。球囊辅助跟踪技术 (BAT)，其中部分瘪的球囊暴露在导管尖端外，以促进其通过狭窄或痉挛的动脉段，由介入心脏病专家引入，该技术的适用性最近已在该领域提出神经干预也是如此。在这里，我们描述了我们在串联闭塞性病变的血管内再通中使用 BAT 技术的经验。

方法

程序于 2013 年 6 月至 2020 年 12 月在一个中心进行。回顾性收集基线临床和影像学数据、手术和随访细节以及临床结果。

结果

在这项研究中，包括 107 名患者，中位年龄 66 岁，入院中位 NIHSS 14 和中位 ASPECTS 8。100 例 (93%) 患者使用 BAT 技术成功再通 ICA，88 例 (82%) 患者成功进行颅内血运重建。BAT 技术没有引起并发症。9 (8%) 名患者发生了术中并发症。40 例（37%）在手术结束时进行了紧急支架植入。6 名 (5%) 患者发生了术后不良事件（脑出血 [ICH]、恶性梗塞）。3 个月时的良好临床结果（改良 Rankin 量表 [mRS] 0-2）为 54（50%），死亡率为 26（24%）。21 例随访期间支架置入延迟。

结论

BAT 技术在串联遮挡中的应用似乎是可行、安全和有效的。等待对该技术的进一步评估。