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Relay-balloon technique for recanalization of acute symptomatic proximal internal carotid artery occlusion with short balloon-tipped guiding catheter landing zone

Abstract
BACKGROUND: Endovascular recanalization of a completely occluded proximal internal carotid artery (ICA) with underlying stenosis may be challenging owing to a possible thrombotic component. This is especially true when the landing zone for a balloon-tipped guiding catheter (BGC) at the bulb portion is insufficient. Sequential application of the balloons of a BGC and an angioplasty catheter may prevent thromboembolism during revascularization. This study analyzed the safety and effectiveness of this relay-balloon technique. METHODS: Ten consecutive patients with acute symptomatic proximal ICA occlusion were treated by the relay-balloon technique. Outcomes analyzed included technical success rate, procedure-related complications, and short-term clinical outcomes. RESULTS: Successful revascularization was achieved in all 10 patients. One patient experienced a post-procedural infarct extension, but there was no change in National Institutes of Health Stroke Scale (NIHSS) score. Mean NIHSS score decreased from 12.0±5.6 (range 0-18) initially to 6.8±5.4 (range 0-18) at discharge. CONCLUSIONS: The relay-balloon technique is safe and effective in the endovascular revascularization of acute symptomatic proximal ICA occlusions, which are at high risk of distal thromboembolism due to insufficient landing zone for the BGC.

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