Utilizing a Guiding Catheter to Improve Endovascular Therapy Outcomes for Acute Vertebrobasilar Artery Occlusion in Patients with Tortuous Vessels

Abstract

Objective Stable and swift placement of a guiding catheter in endovascular therapies for acute vertebrobasilar artery occlusion is often difficult because of the tortuous bends of the vertebral or subclavian artery especially in older people. The use of a delivery assist guiding catheter (DAGC) shortens the time with stable support to deliver a therapeutic treatment catheter to the target lesions. Herein, we reported the clinical and radiographic outcomes in endovascular therapies utilizing the DAGC for acute vertebrobasilar artery occlusions in actual clinical settings.

Materials and Methods Between January 2018 and December 2021, 33 consecutive patients (males, 20[60.6%]; median age, 78 years) using a DAGC for acute vertebrobasilar artery occlusion were analyzed retrospectively. Reperfusion was graded using postinterventional angiograms based on the “thrombolysis in cerebral infarction” (TICI) classification. Furthermore, the time from puncture to recanalization and the rate of effective recanalization achievement were investigated.

Results Effective recanalization with TICI 2b or 3 was achieved in 28 (84.8%) patients, and the median time from puncture to recanalization was only 44 minutes, despite the high rate of older patients in our cohort. In contrast, asymptomatic intracranial hemorrhage as a complication was observed in only 3 (9.1%) patients.

Conclusion The DAGC contributes to the shortening of recanalization time and improves the outcomes of endovascular therapies for acute vertebrobasilar artery occlusion.

Keywords

acute vertebrobasilar artery occlusion - endovascular therapy - delivery assist guiding catheter - tortuous vessels - aspiration catheter

Authors' Contributions

T.H. was involved in conceptualization, methodology, investigation. T.O. helped in writing the original draft. A.T. did formal analysis. T.I., R.K., and K.S. helped in investigation. S.O. supervised the study.

Ethical Approval

This study was approved by the institutional ethics committee (IEC) (No.253).

Publication History

Article published online:
27 May 2024

• References

• 1 Berkhemer OA, Fransen PS, Beumer D. et al; MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372 (01) 11-20
• 2 Saver JL, Goyal M, Bonafe A. et al; SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372 (24) 2285-2295
• 3 Jovin TG, Chamorro A, Cobo E. et al; REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372 (24) 2296-2306
• 4 Goyal M, Demchuk AM, Menon BK. et al; ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372 (11) 1019-1030
• 5 Langezaal LCM, van der Hoeven EJRJ, Mont'Alverne FJA. et al; BASICS Study Group. Endovascular therapy for stroke due to basilar-artery occlusion. N Engl J Med 2021; 384 (20) 1910-1920
• 6 Liu X, Dai Q, Ye R. et al; BEST Trial Investigators. Endovascular treatment versus standard medical treatment for vertebrobasilar artery occlusion (BEST): an open-label, randomised controlled trial. Lancet Neurol 2020; 19 (02) 115-122
• 7 Tao C, Nogueira RG, Zhu Y. et al; ATTENTION Investigators. Trial of endovascular treatment of acute basilar-artery occlusion. N Engl J Med 2022; 387 (15) 1361-1372
• 8 Jovin TG, Li C, Wu L. et al; BAOCHE Investigators. Trial of thrombectomy 6 to 24 hours after stroke due to basilar-artery occlusion. N Engl J Med 2022; 387 (15) 1373-1384
• 9 Himeno T, Ota S, Ohtonari T. et al. Efficacy of the insertion-support guiding catheter in approaching intracranial or craniocervical lesions in patients with the difficulty of extracranial trans-arterial access. J Neuroendovasc Ther 2020; 14 (01) 36-42
• 10 Turk AS, Frei D, Fiorella D. et al. ADAPT FAST study: a direct aspiration first pass technique for acute stroke thrombectomy. J Neurointerv Surg 2014; 6 (04) 260-264
• 11 Kang D-H, Hwang Y-H, Kim Y-S, Park J, Kwon O, Jung C. Direct thrombus retrieval using the reperfusion catheter of the penumbra system: forced-suction thrombectomy in acute ischemic stroke. AJNR Am J Neuroradiol 2011; 32 (02) 283-287
• 12 Turk AS, Spiotta A, Frei D. et al. Initial clinical experience with the ADAPT technique: a direct aspiration first pass technique for stroke thrombectomy. J Neurointerv Surg 2014; 6 (03) 231-237
• 13 Deshaies EM. Tri-axial system using the Solitaire-FR and Penumbra Aspiration Microcatheter for acute mechanical thrombectomy. J Clin Neurosci 2013; 20 (09) 1303-1305
• 14 Humphries W, Hoit D, Doss VT. et al. Distal aspiration with retrievable stent assisted thrombectomy for the treatment of acute ischemic stroke. J Neurointerv Surg 2015; 7 (02) 90-94
• 15 Alawieh A, Vargas J, Turner RD. et al. Equivalent favorable outcomes possible after thrombectomy for posterior circulation large vessel occlusion compared with the anterior circulation: the MUSC experience. J Neurointerv Surg 2018; 10 (08) 735-740
• 16 Gerber JC, Daubner D, Kaiser D. et al. Efficacy and safety of direct aspiration first pass technique versus stent-retriever thrombectomy in acute basilar artery occlusion-a retrospective single center experience. Neuroradiology 2017; 59 (03) 297-304