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Endovascular Recanalization of Tandem Internal Carotid Occlusions Using the Balloon-assisted Tracking Technique.

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Abstract

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.

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Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The research was conducted as part of a doctoral program at the Doctoral School of the University of Pécs, Faculty of Health Sciences, Hungary.

Author information

Authors and Affiliations

  1. Neurovascular and Interventional Unit, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary

    Csaba Nagy, István Gubucz, Sándor Nardai, Gábor Lenzsér, Gábor Bajzik, Mariann Moizs, Imre Repa & Zsolt Vajda

  2. Department of Neurosurgery, University of Pécs, Pécs, Hungary

    Csaba Nagy, Gábor Lenzsér & Zsolt Vajda

  3. Department of Emergency Medicine, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary

    Júlia Héger

  4. Department of Surgery, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary

    Gábor Balogh

  5. National Institute of Clinical Neurosciences, Budapest, Hungary

    István Gubucz

  6. Department of Neurosurgery, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary

    Máté Fehér

  7. Department of Neurology, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary

    Ferenc Nagy

Authors
  1. Csaba Nagy
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  2. Júlia Héger
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  3. Gábor Balogh
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  4. István Gubucz
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  5. Sándor Nardai
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  6. Gábor Lenzsér
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  7. Gábor Bajzik
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  9. Mariann Moizs
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  12. Zsolt Vajda
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Contributions

All authors made a significant contribution to the study and to manuscript preparation. CN, JH, FN and ZV contributed to study conception and design, CN, JH, GBG, IG, SN, GL, MF and GBK contributed to data acquisition and MM and IR contributed to data interpretation and analysis. CN and ZV drafted the manuscript, GL, MF, GBK, MM, IR and FN critically revised the paper, and IR contributed significantly to the intellectual content. CN, MM, IR, FN and ZV approved the final version of the manuscript.

Corresponding author

Correspondence to Zsolt Vajda.

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Conflict of interest

C. Nagy, J. Héger, G. Balogh, I. Gubucz, S. Nardai, G. Lenzsér, G. Bajzik, M. Fehér, M. Moizs, I. Repa, F. Nagy and Z. Vajda declare that they have no competing interests.

Ethical standards

This retrospective analysis was conducted with approval of the Moritz Kaposi Teaching Hospital Institutional Review Board (IKEB/02163-000/2020). Consent to participate: informed consent for the study was waived due to the retrospective nature of the study; however, patients or a family member gave informed consent for the endovascular procedures. Consent for publication: publication has been approved by all co-authors.

Additional information

Availability of Data and Material

Questions regarding details not seen in the manuscript should be addressed to Zsolt Vajda M.D., Ph.D., the corresponding author, who maintains the clinical research files and provides access to the data upon reasonable request.

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Nagy, C., Héger, J., Balogh, G. et al. Endovascular Recanalization of Tandem Internal Carotid Occlusions Using the Balloon-assisted Tracking Technique.. Clin Neuroradiol 32, 375–384 (2022). https://doi.org/10.1007/s00062-021-01078-2

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  • DOI: https://doi.org/10.1007/s00062-021-01078-2

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