Wang Maud, Elens Stephanie, Bonnet Thomas, Halut Marin, Suarez Juan Vazquez, Mine Benjamin, Lubicz Boris, Guenego Adrien
Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium.
Front Neurol. 2022 Jul 26;13:934690. doi: 10.3389/fneur.2022.934690. eCollection 2022.
Stent and balloon anchor techniques have been described to obtain distal support and straighten catheter loops, stabilize microcatheters in giant aneurysms, or access distal tortuous anatomy during thrombectomy. These techniques require catheterization of distal arteries with a microcatheter but tortuosity and length issues may render it challenging, precluding the distal unsheathing of a classical auto-expandable stentretriever with the anchor technique.
Therefore, we developed the so-called Anch'Or Harpoon Technique using a manually expandable stent retriever, the Tigertriever 13 (Rapid Medical, Yoqneam, Israel). Here, the stent retriever is not unsheathed but pushed out of a microcatheter, and then advanced as far as possible before manual opening.
This technique may be used in 2 different situations. First, in the case of vessel tortuosity if the microcatheter can't be advanced as far as the physician wants: the Tigertriever 13 could be delivered through the microcatheter without having to unsheathe it, and be advanced and opened distally to its microcatheter to establish a stable anchor prior to advancing the guiding, intermediate, and micro-catheters (Anchor technique). The second situation is when distal occlusions lead to length issues; the microcatheter may be too short to cross a distal clot: the Tigertriever 13 could then be pushed out of the microcatheter, and be used to cross a sub-occlusive clot as it has a soft shaped distal tip and the physician has a visual on the artery beyond the sub-occlusion. Then, the Tigertriever would be manually expanded through the clot and retrieved (Harpoon technique) to obtain a recanalization.
已描述了支架和球囊锚定技术，用于获得远端支撑并拉直导管环、在巨大动脉瘤中稳定微导管或在取栓过程中进入远端迂曲的解剖结构。这些技术需要用微导管对远端动脉进行插管，但迂曲度和长度问题可能使其具有挑战性，从而无法使用锚定技术对传统的自膨式支架取栓器进行远端解鞘。
因此，我们开发了所谓的锚定鱼叉技术，使用手动可扩张的支架取栓器Tigertriever 13（Rapid Medical，以色列约克尼姆）。在此技术中，支架取栓器不是解鞘而是从微导管中推出，然后在手动打开之前尽可能向前推进。
该技术可用于两种不同情况。首先，在血管迂曲的情况下，如果微导管无法按医生期望的那样推进：Tigertriever 13可以通过微导管输送而无需解鞘，并在微导管远端向前推进并打开，以在推进引导导管、中间导管和微导管之前建立稳定的锚定（锚定技术）。第二种情况是当远端闭塞导致长度问题时；微导管可能太短而无法穿过远端血栓：此时Tigertriever 13可以从微导管中推出，并用于穿过亚闭塞性血栓，因为它具有柔软形状的远端尖端，并且医生可以看到亚闭塞远端的动脉。然后，Tigertriever将通过血栓手动扩张并取出（鱼叉技术）以实现再通。
