Salem Mohamed M, Kvint Svetlana, Choudhri Omar A, Burkhardt Jan-Karl
Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2021 Dec;156:e175-e182. doi: 10.1016/j.wneu.2021.09.026. Epub 2021 Sep 14.
The Walrus Balloon Guided System Catheter is a new generation of balloon guide catheter (BGC) designed to bypass some technical limitations of conventional BGC devices. Their utility in cervical carotid disease treatment has not been reported. We report our preliminary experience in cervical carotid treatment using the Walrus BGC to perform a modified endovascular transcarotid artery revascularization technique.
Patients with cervical carotid disease undergoing endovascular treatment using the Walrus BGC at our institution were identified. The pertinent baseline demographics and procedural outcomes were collected and analyzed.
Twelve patients were included (median age, 70; 58.3% females). All patients had an imaging-confirmed cervical carotid disease that indicated intervention: 6 with high-grade cervical arteriosclerotic carotid stenosis, 2 with intraluminal thrombi, 1 with traumatic carotid dissection, and 3 patients with cervical carotid tandem occlusion along with acute ischemic stroke secondary to large vessel occlusion that required mechanical thrombectomy. Carotid artery stenting was performed in all cases, except 2 of the 3 mechanical thrombectomy cases (angioplasty only). All patients had at least periprocedural follow-up of 30 days, with no stroke, myocardial infarction, or death encountered.
We describe a modified endovascular transcarotid artery revascularization technique. We used a standard femoral access to navigate the Walrus catheter in the common carotid artery, followed by balloon inflation for proximal flow arrest or flow reversal (when connected to the aspiration pump) to deploy the carotid stent across the stenosis, while avoiding distal external carotid artery balloon occlusion. Successful treatment was achieved in all cases, with no periprocedural complications encountered.
海象球囊引导系统导管是新一代球囊引导导管（BGC），旨在克服传统BGC设备的一些技术局限性。其在颈段颈动脉疾病治疗中的应用尚未见报道。我们报告了使用海象BGC进行改良血管内颈动脉再血管化技术治疗颈段颈动脉疾病的初步经验。
确定在我们机构使用海象BGC进行血管内治疗的颈段颈动脉疾病患者。收集并分析相关的基线人口统计学和手术结果。
纳入12例患者（中位年龄70岁；女性占58.3%）。所有患者均经影像学证实存在颈段颈动脉疾病且需要干预：6例为高度颈动脉硬化性颈动脉狭窄，2例为腔内血栓形成，1例为创伤性颈动脉夹层，3例为颈段颈动脉串联闭塞并伴有继发于大血管闭塞的急性缺血性卒中，需要进行机械取栓。除3例机械取栓病例中的2例（仅行血管成形术）外，所有病例均进行了颈动脉支架置入术。所有患者至少有30天的围手术期随访，未发生卒中、心肌梗死或死亡。
我们描述了一种改良的血管内颈动脉再血管化技术。我们采用标准股动脉入路将海象导管插入颈总动脉，然后球囊扩张以实现近端血流阻断或血流逆转（连接抽吸泵时），从而在狭窄部位置入颈动脉支架，同时避免远端颈外动脉球囊闭塞。所有病例均成功治疗，未发生围手术期并发症。
