Angiographical Features of Acute Stroke Patients with Carotid Artery Embolic Occlusion Recanalized by Suction with Syringe via Balloon Guiding Catheter

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Objective: This study was conducted to clarify the characteristics of preprocedural vascular images in patients with acute embolic occlusion of the carotid artery in whom the internal carotid artery (ICA) could be recanalized by manual suction with syringe via the balloon guiding catheter (SS-BGC) alone.

Methods: The subjects were 64 consecutive patients who underwent SS-BGC for carotid artery embolic occlusion at our institution between May 2006 and September 2017. The subjects were classified into those who with recanalization (R-SS-BGC group) and no recanalization (N-SS-BGC) of ICA by SS-BGC alone, and the background factors including findings of preprocedural vascular imaging and outcomes were compared between the two groups.

Results: The R-SS-BGC and N-SS-BGC groups consisted of 16 and 48 patients, respectively. In the R-SS-BGC/N-SS-BGC groups, the horizontal segment of the ipsilateral anterior cerebral artery (A1) was patent in 15/24 (94/50%) and the horizontal segment of the ipsilateral middle cerebral artery (M1) was patent in 6/16 (38/34%) on preprocedural MRA. The ipsilateral posterior communicating artery (PcomA) was patent in 3/14 (19/29%) and the ipsilateral ophthalmic artery (OphA) was patent in 1/14 (6/29%) on preprocedural angiography. The median duration of operation was 39/86.5 minutes, and complete recanalization could be achieved in 15/34 (94/71%). The outcome was favorable in 10/11 (63/23%).

Conclusion: In the R-SS-BGC group, the percentages of patients with patent ipsilateral A1 and M1 were high, and the percentages of those with patent ipsilateral PcomA and OphA were low.