Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Science, Buffalo, New York, USA.
J Neurointerv Surg. 2022 Jul;14(7):709-717. doi: 10.1136/neurintsurg-2021-018126. Epub 2021 Oct 22.
The Walrus balloon guide catheter (BGC) is a new generation of BGC, designed to eliminate conventional limitations during mechanical thrombectomy.
To report a multi-institutional experience using this BGC for proximal flow control (PFC) in the setting of carotid artery angioplasty/stenting (CAS) in elective (eCAS) and tandem strokes (tCAS).
Prospectively maintained databases at 8 North American centers were queried to identify patients with cervical carotid disease undergoing eCAS/tCAS with a Walrus BGC.
110 patients (median age 68, 64.6% male), 80 (72.7%) undergoing eCAS and 30 (27.3%) tCAS procedures, were included (median cervical carotid stenosis 90%; 46 (41.8%) with contralateral stenosis). Using a proximal flow-arrest technique in 95 (87.2%) and flow-reversal in 14 (12.8%) procedures, the Walrus was navigated into the common carotid artery successfully in all cases despite challenging arch anatomy (31, 28.2%), with preferred femoral access (103, 93.6%) and in monitored anesthesia care (90, 81.8%). Angioplasty and distal embolic protection devices (EPDs) were used in 91 (83.7%) and 58 (52.7%) procedures, respectively. tCAS led to a modified Thrombolysis in Cerebral Infarction 2b/3 in all cases. Periprocedural ischemic stroke (up to 30 days postoperatively) rate was 0.9% (n=1) and remote complications occurred in 2 (1.8%) cases. Last follow-up modified Rankin Scale score of 0-2 was seen in 95.3% of eCAS cohort, with no differences in complications in the eCAS subgroup between PFC only versus PFC and distal EPD (median follow-up 4.1 months).
Walrus BGC for proximal flow control is safe and effective during eCAS and tCAS. Procedural success was achieved in all cases, with favorable safety and functional outcomes on short-term follow-up.
海象球囊引导导管（BGC）是新一代 BGC，旨在消除机械血栓切除术过程中的常规限制。
报告在颈动脉血管成形术/支架置入术（CAS）中使用这种 BGC 进行近端血流控制（PFC）的多中心经验，包括择期（eCAS）和串联（tCAS）情况。
在 8 个北美中心的前瞻性维护数据库中查询了接受海象 BGC 行颈内颈动脉疾病治疗的患者。
110 例患者（中位年龄 68 岁，64.6%为男性），80 例（72.7%）行 eCAS，30 例（27.3%）行 tCAS，包括中位颈内颈动脉狭窄 90%；46 例（41.8%）存在对侧狭窄）。在 95 例（87.2%）中采用近端血流阻断技术，在 14 例（12.8%）中采用血流反转技术，尽管存在挑战性的弓部解剖结构（31 例，28.2%），所有情况下均成功将海象 BGC 导引导管置入颈总动脉，首选股动脉入路（103 例，93.6%）和监测麻醉下进行（90 例，81.8%）。91 例（83.7%）和 58 例（52.7%）分别使用了血管成形术和远端血栓保护装置（EPD）。所有 tCAS 均导致改良的血栓溶解 2b/3 级。围手术期缺血性卒中（术后 30 天内）发生率为 0.9%（n=1），2 例（1.8%）发生远处并发症。eCAS 队列中，95.3%的患者在最后一次随访时改良 Rankin 量表评分为 0-2 分，仅进行 PFC 与 PFC 和远端 EPD 之间的 eCAS 亚组并发症无差异（中位随访时间为 4.1 个月）。
海象 BGC 用于近端血流控制在 eCAS 和 tCAS 中是安全有效的。所有病例均获得手术成功，短期随访安全性和功能结局良好。
