Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Efficacy of Proximal Aspiration Thrombectomy for Using Balloon-Tipped Guide Catheter in Acute Intracranial Internal Carotid Artery Occlusion

  • Kim, Yong-Won (Department of Radiology, Cerebrovascular Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University) ;
  • Kang, Dong-Hun (Department of Radiology, Cerebrovascular Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University) ;
  • Hwang, Yang-Ha (Department of Neurology, Cerebrovascular Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University) ;
  • Park, Jaechan (Department of Neurosurgery, Cerebrovascular Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University) ;
  • Kim, Yong-Sun (Department of Radiology, Cerebrovascular Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University)
  • Received : 2015.11.30
  • Accepted : 2016.03.20
  • Published : 2016.07.01
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Abstract

Objective : Mechanical thrombectomy (MT) for acute intracranial internal carotid artery (ICA) occlusion is often complicated by difficult revascularization and non-involved territory embolization possibly related with larger clot-burden. This study aims to evaluate the efficacy of proximal aspiration thrombectomy (PAT) using a balloon-tipped guide catheter for clot-burden reduction in such cases with period-to-period analysis (period 1 : standard MT without PAT; period 2 : PAT first, then standard MT for the remaining occlusion). Methods : Eighty-six patients who underwent MT for acute intracranial ICA occlusion were included in this analysis from the prospectively maintained stroke registry (33 patients in period 1 and 53 in period 2). In period 2, 'responder' was defined as a case where some amount of clot was retrieved by PAT and the following angiography showed partial or full recanalization. Results : Fifteen of fifty-three patients in period 2 (28.3%) were 'responders' to PAT. There was a significantly higher incidence of atrial fibrillation in the 'responder' subgroup. Period 2 showed a significantly shorter puncture-to-reperfusion time (94.5 minutes vs. 56.0 minutes; p=0.002), a significantly higher Thrombolysis in Cerebral Infarction of 2b-3 reperfusion (45.5% vs. 73.6%; p=0.009), but only a trend for better 3-month favorable outcome (mRS 0-2; 36.4% vs. 54.7%; p=0.097). There was no increase in the incidence of procedure-related complications or intracranial hemorrhage in period 2. Conclusion : A strategy of PAT before standard MT may result in shorter puncture-to-reperfusion time and better angiographic outcome than a strategy of standard MT for acute intracranial ICA occlusion.

Keywords

References

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