Initial Clinical Experience of Repeat Thrombectomy with a Retrieval Stent (RTRS) with Continuous Proximal Flow Arrest by Balloon Guide Catheter for Acute Intracranial Carotid Occlusion

Figure 1

Illustration of the repeat thrombectomy with a retrieval stent (RTRS) technique with continuous proximal flow arrest by a balloon guide catheter for acute intracranial ICA occlusion. (a) DSA shows ICA terminus occlusion involving the MCA and ACA. The retrieval stent is unsheathed at the occlusion site. After at least 3 minutes, the balloon is inflated to arrest the anterograde flow from the ICA, and then the fully deployed Solitaire stent is partially resheathed. Together with the delivery microcatheter and distal access catheter, the stent is gently pulled back under continuous suction achieved with a syringe. This procedure is called primary clot retrieval. (b) The BGC was blocked by a thrombus, and there was no blood flow through the BGC. The BGC was kept inflated, and continuous suction was achieved via a syringe. (c) The microcatheter and stent were advanced together directly into the site, which was close to the distal tip of the BGC. (d) The stent is unsheathed at the site close to the distal tip of the BGC, and then the stent together with the delivery microcatheter is retrieved back under continuous suction. This procedure is called rescue clot retrieval. (e) Blood flow without a thrombus comes out of BGC, and gentle injection contrast via the BGC was performed to confirm successful reperfusion. (f) The BGC was deflated. ICA: internal carotid artery; DSA: digital subtraction angiography; BGC: balloon guide catheter.

(a)

(b)

(c)

(d)

(e)

(f)