S A Ansari1,2,3, M Darwish4,5, R N Abdalla4,6, D R Cantrell4,3, A Shaibani4,3, M C Hurley4,3, B S Jahromi4,3, M B Potts4,3. 1. From the Departments of Radiology (S.A.A., M.D., R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.) s-ansari@northwestern.edu. 2. Neurology (S.A.A.). 3. Neurological Surgery (S.A.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 4. From the Departments of Radiology (S.A.A., M.D., R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.). 5. Department of Neurology (M.D.), Assiut University, Assiut, Egypt. 6. Department of Radiology (R.N.A.), Ain Shams University, Cairo, Egypt.
Abstract
BACKGROUND AND PURPOSE: Adjunctive techniques to stent retriever thrombectomy include balloon-guide catheters and/or distal access catheters for aspiration. We describe a novel technique using a flexible, 6 French 088 distal guide sheath advanced past the skull base to augment mechanical thrombectomy. We studied the relative safety and efficacy of this technique in the setting of a combined stent retriever-distal access catheter aspiration thrombectomy protocol. MATERIALS AND METHODS: We performed a retrospective case-control study of intracranial internal carotid artery or M1-M2 middle cerebral artery occlusions requiring mechanical thrombectomy. Patients were divided into 2 groups based on thrombectomy techniques: conventional stent retriever with distal access catheter aspiration without (standard) and with adjunctive GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery (GUARD). Using propensity score matching, we compared procedural safety, reperfusion efficacy using the modified Thrombolysis in Cerebral Infarction scale and clinical outcomes with the modified Rankin Scale. RESULTS: In comparing the GUARD (45 patients) versus standard (45 matched case controls) groups, there were no significant differences in demographics, NIHSS presentations, IV rtPA use, median onset-to-groin puncture times, procedural complications, symptomatic intracranial hemorrhage, or mortality. The GUARD group demonstrated significantly higher successful mTICI ≥2b reperfusion rates (98% versus 80%, P = .015) and improved functional mRS ≤2 outcomes (67% versus 43%, P = .04), with independent effects of the GUARD technique confirmed in a multivariable logistic regression model. CONCLUSIONS: The GUARD technique during mechanical thrombectomy with combined stent retrieval-distal access catheter aspiration is safe and effective in improving reperfusion and clinical outcomes.
BACKGROUND AND PURPOSE: Adjunctive techniques to stent retriever thrombectomy include balloon-guide catheters and/or distal access catheters for aspiration. We describe a novel technique using a flexible, 6 French 088 distal guide sheath advanced past the skull base to augment mechanical thrombectomy. We studied the relative safety and efficacy of this technique in the setting of a combined stent retriever-distal access catheter aspiration thrombectomy protocol. MATERIALS AND METHODS: We performed a retrospective case-control study of intracranial internal carotid artery or M1-M2 middle cerebral artery occlusions requiring mechanical thrombectomy. Patients were divided into 2 groups based on thrombectomy techniques: conventional stent retriever with distal access catheter aspiration without (standard) and with adjunctive GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery (GUARD). Using propensity score matching, we compared procedural safety, reperfusion efficacy using the modified Thrombolysis in Cerebral Infarction scale and clinical outcomes with the modified Rankin Scale. RESULTS: In comparing the GUARD (45 patients) versus standard (45 matched case controls) groups, there were no significant differences in demographics, NIHSS presentations, IV rtPA use, median onset-to-groin puncture times, procedural complications, symptomatic intracranial hemorrhage, or mortality. The GUARD group demonstrated significantly higher successful mTICI ≥2b reperfusion rates (98% versus 80%, P = .015) and improved functional mRS ≤2 outcomes (67% versus 43%, P = .04), with independent effects of the GUARD technique confirmed in a multivariable logistic regression model. CONCLUSIONS: The GUARD technique during mechanical thrombectomy with combined stent retrieval-distal access catheter aspiration is safe and effective in improving reperfusion and clinical outcomes.
Authors: Francesco Massari; Nils Henninger; Juan Diego Lozano; Anand Patel; Anna Luisa Kuhn; Mary Howk; Mary Perras; Christopher Brooks; Matthew J Gounis; Peter Kan; Ajay K Wakhloo; Ajit S Puri Journal: Interv Neuroradiol Date: 2016-02-22 Impact factor: 1.610
Authors: Waleed Brinjikji; Robert M Starke; M Hassan Murad; David Fiorella; Vitor M Pereira; Mayank Goyal; David F Kallmes Journal: J Neurointerv Surg Date: 2017-07-28 Impact factor: 5.836
Authors: Gregory W Albers; Michael P Marks; Stephanie Kemp; Soren Christensen; Jenny P Tsai; Santiago Ortega-Gutierrez; Ryan A McTaggart; Michel T Torbey; May Kim-Tenser; Thabele Leslie-Mazwi; Amrou Sarraj; Scott E Kasner; Sameer A Ansari; Sharon D Yeatts; Scott Hamilton; Michael Mlynash; Jeremy J Heit; Greg Zaharchuk; Sun Kim; Janice Carrozzella; Yuko Y Palesch; Andrew M Demchuk; Roland Bammer; Philip W Lavori; Joseph P Broderick; Maarten G Lansberg Journal: N Engl J Med Date: 2018-01-24 Impact factor: 91.245
Authors: Raul G Nogueira; Ashutosh P Jadhav; Diogo C Haussen; Alain Bonafe; Ronald F Budzik; Parita Bhuva; Dileep R Yavagal; Marc Ribo; Christophe Cognard; Ricardo A Hanel; Cathy A Sila; Ameer E Hassan; Monica Millan; Elad I Levy; Peter Mitchell; Michael Chen; Joey D English; Qaisar A Shah; Frank L Silver; Vitor M Pereira; Brijesh P Mehta; Blaise W Baxter; Michael G Abraham; Pedro Cardona; Erol Veznedaroglu; Frank R Hellinger; Lei Feng; Jawad F Kirmani; Demetrius K Lopes; Brian T Jankowitz; Michael R Frankel; Vincent Costalat; Nirav A Vora; Albert J Yoo; Amer M Malik; Anthony J Furlan; Marta Rubiera; Amin Aghaebrahim; Jean-Marc Olivot; Wondwossen G Tekle; Ryan Shields; Todd Graves; Roger J Lewis; Wade S Smith; David S Liebeskind; Jeffrey L Saver; Tudor G Jovin Journal: N Engl J Med Date: 2017-11-11 Impact factor: 91.245
Authors: Christian Maegerlein; Sebastian Mönch; Tobias Boeckh-Behrens; Manuel Lehm; Dennis M Hedderich; Maria Teresa Berndt; Silke Wunderlich; Claus Zimmer; Johannes Kaesmacher; Benjamin Friedrich Journal: J Neurointerv Surg Date: 2017-12-08 Impact factor: 5.836
Authors: Aquilla S Turk; Adnan Siddiqui; Johanna T Fifi; Reade A De Leacy; David J Fiorella; Eugene Gu; Elad I Levy; Kenneth V Snyder; Ricardo A Hanel; Amin Aghaebrahim; B Keith Woodward; Harry R Hixson; Mohammad I Chaudry; Alejandro M Spiotta; Ansaar T Rai; Donald Frei; Josser E Delgado Almandoz; Mike Kelly; Adam Arthur; Blaise Baxter; Joey English; Italo Linfante; Kyle M Fargen; J Mocco Journal: Lancet Date: 2019-03-09 Impact factor: 79.321
Authors: R N Abdalla; D R Cantrell; A Shaibani; M C Hurley; B S Jahromi; M B Potts; S A Ansari Journal: AJNR Am J Neuroradiol Date: 2021-04-22 Impact factor: 4.966