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Han N, Ma L, Zhao L, Xu G, Jia Y, Wang H. The Dilator-Dotter technique can successfully treat tandem lesions of posterior circulation. Medicine (Baltimore) 2024; 103:e37044. [PMID: 38277540 PMCID: PMC10817093 DOI: 10.1097/md.0000000000037044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 01/03/2024] [Indexed: 01/28/2024] Open
Abstract
In this study, we applied the Dilator-Dotter technique, a catheter-based angioplasty, to cross through severely stenotic or occluded vertebral arteries during mechanical thrombectomy, and we explored its efficacy and safety in treating tandem lesions of posterior circulation. We performed a retrospective analysis of patients with acute stroke caused by tandem lesions of posterior circulation treated with the Dilator-Dotter technique and thrombectomy between July 2017 and December 2021. In addition to collecting clinical, radiographic, and procedural data from patient records, we also collected information about surgical complications and outcome. We enrolled 9 patients for this study. In all cases, the vertebral artery (VA) on the affected side was crossed through via the Dilator-Dotter technique, and mechanical thrombectomy was successfully performed. The average time from groin puncture to revascularization (TICI 2B-3) was 26 minutes (range 16-50 minutes). Eight patients (89%) achieved complete recanalization with TICI 3, and only 1 patient suffered from thrombus escape to the posterior cerebral artery. Eight patients underwent VA stenting, while the remaining patient was excluded from this procedure because a postoperative brain CT scan recorded obvious staining of the contrast medium within the infarcted area. Five patients had modified Rankin Scale scores ≤ 3 at the 3-month follow-up examination, and 2 patients died due to postoperative cerebral hemorrhage and severe ischemia. The Dilator-Dotter technique may represent a safe and effective treatment for tandem lesions of posterior circulation. Using this method, the lesions can be rapidly recanalized and treated.
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Affiliation(s)
- Ning Han
- Department of Graduate School, Hebei Medical University, Shijiazhuang, Hebei, China
- Neurointerventional department, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Liang Ma
- Neurointerventional department, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Lei Zhao
- Neurological Intensive Care Unit, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Guodong Xu
- Neurointerventional department, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yangjuan Jia
- Department of Emergency Medicine, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Hebo Wang
- Department of Graduate School, Hebei Medical University, Shijiazhuang, Hebei, China
- Neurology Department, Hebei General Hospital, Shijiazhuang, Hebei, China
- Hebei Provincial Key Laboratory of Cerebral Networks and Cognitive Disorders, Shijiazhuang, Hebei, China
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Siddiq F, Bhagavan S, Ishfaq MF, Jaura A, Bhatti IA, Gomez CR, Qureshi AI. Balloon-Assisted Catheterization of Occluded Carotid Artery (BOCA) Technique in Acute Stroke. Oper Neurosurg (Hagerstown) 2023; 25:190-198. [PMID: 37133290 DOI: 10.1227/ons.0000000000000723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/08/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Acute ischemic stroke from tandem occlusion of internal carotid artery (ICA) poses a technical challenge to neurointerventionalists. OBJECTIVE To present a novel balloon-assisted catheterization of occluded carotid artery (BOCA) technique used for rapid and effective catheterization of occluded/critically stenosed ICA in tandem occlusion. METHODS A retrospective review of 10 patients with tandem carotid occlusion, treated with BOCA technique for revascularization between July 2020 and June 2021, was performed. Clinical, radiographic, and procedural data; details of BOCA technique; complications; and outcomes were reviewed. RESULTS Of the 10 patients, 8 (80%) had complete occlusion of the cervical ICA and the remaining 2 had high-grade stenosis with poor intracranial flow. The mean age was 63.2 years. The mean presenting NIH Stroke Scale was 13.4. The BOCA technique resulted in recanalization of ICA in all patients and allowed mechanical thrombectomy of middle cerebral artery. Thrombolysis in cerebral infarction grade 2b/3 was achieved in all 10 patients. The mean groin-to-reperfusion time was 41.4 minutes. The mean internal carotid artery stenosis was 99.7% preoperatively and 41.1% postoperatively. Only one patient needed stent at the end of the procedure because of dissection. CONCLUSION The BOCA technique can be used in distal first approach for acute stroke from tandem ICA occlusion. This technique allows direct guide catheterization of occluded ICA by tracking over a partially inflated balloon.
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Affiliation(s)
- Farhan Siddiq
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | - Sachin Bhagavan
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - M Fawad Ishfaq
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Attiya Jaura
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
| | | | - Camilo R Gomez
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri, USA
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Mizowaki T, Fujita A, Imura J, Nakahara M, Tanaka H, Takaishi Y, Kondoh T. Ostial common carotid artery occlusion and balloon-mounted stenting: Implication of embolic protection device in tandem lesion. Radiol Case Rep 2021; 16:2783-2786. [PMID: 34367395 PMCID: PMC8326589 DOI: 10.1016/j.radcr.2021.06.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 11/18/2022] Open
Abstract
Ostial common carotid artery (CCA) stenosis is rare, compared to extracranial internal carotid artery bifurcation lesions. In cases of a tandem lesion, the proximal lesion usually involves the extracranial internal carotid artery, and the ostial CCA is rarely implicated. A 69-year-old woman who underwent 3 months of antiplatelet therapy for asymptomatic, right ostial, severely calcified CCA stenosis presented with sudden onset left hemiparesis. Radiographic examination revealed an ostial CCA-intracranial artery tandem lesion. After intracranial revascularization using a clot retrieval stent, we performed the endovascular treatment with a balloon-mounted stent using an embolic protection device. This procedure may be superior to others because it is possible to achieve early intracranial revascularization and prevent distal embolism during the complete treatment of proximal lesions.
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Affiliation(s)
- Takashi Mizowaki
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, Kobe, Hyogo, 654-0048, Japan
| | - Atsushi Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Jun Imura
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, Kobe, Hyogo, 654-0048, Japan
| | - Masahiro Nakahara
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, Kobe, Hyogo, 654-0048, Japan
| | - Hirotomo Tanaka
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, Kobe, Hyogo, 654-0048, Japan
| | - Yoshiyuki Takaishi
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, Kobe, Hyogo, 654-0048, Japan
| | - Takeshi Kondoh
- Department of Neurosurgery, Shinsuma General Hospital, 3-1-14 Kinugake-cho, Suma-ku, Kobe, Hyogo, 654-0048, Japan
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Amuluru K, Sahlein D, Al-Mufti F, Payner T, Kulwin C, DeNardo A, Scott J. The Dilator-Dotter Technique: A Modified Method of Rapid Internal Carotid Artery Revascularization in Acute Ischemic Stroke. AJNR Am J Neuroradiol 2020; 41:1863-1868. [PMID: 32883663 DOI: 10.3174/ajnr.a6733] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/15/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Acute ischemic stroke due to tandem occlusive lesions involves high-grade ICA stenosis or occlusion with a distal intracranial occlusion. Several approaches and devices exist in the treatment of tandem occlusions; however, a consensus on the optimal technique does not exist. The Dotter technique is a method of catheter-based angioplasty to recanalize cervical ICA occlusions. We present a modified dilator-Dotter technique, which involves a polyethylene, tapered inner dilator to initially cross the occlusion, followed by guide catheterization and subsequent intracranial thrombectomy. The purpose of this study was to examine the safety and efficacy of this dilator-Dotter technique. MATERIALS AND METHODS We performed a retrospective review of patients with acute stroke due to tandem ICA intracranial occlusions, treated with our dilator-Dotter technique and thrombectomy between June 2018 and December 2019. We examined clinical, radiographic, and procedural data, as well as complications and outcomes. RESULTS Thirty-two patients were included. In 100% of cases, the dilator-Dotter technique resulted in ICA recanalization allowing successful thrombectomy. TICI 2b-3 revascularization was obtained in 31 patients (96%), within an average time of 25 minutes. The average preprocedural ICA stenosis was 98%, including 23 patients (72%) with complete occlusion. Following the dilator-Dotter technique, average ICA stenosis improved to 59%. There were no instances of death, iatrogenic dissection, emboli to new territory, or symptomatic intracranial hemorrhage. CONCLUSIONS The dilator-Dotter technique may be a safe and effective modification of the traditional Dotter technique in allowing rapid ICA recanalization in cases of acute ischemic stroke due to tandem occlusions.
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Affiliation(s)
- K Amuluru
- From the Division of Neurointerventional Radiology (K.A., D.S., A.D., J.S.) .,Division of Neurointerventional Radiology (K.A., D.S., A.D., J.S.)
| | - D Sahlein
- From the Division of Neurointerventional Radiology (K.A., D.S., A.D., J.S.).,Division of Neurointerventional Radiology (K.A., D.S., A.D., J.S.)
| | - F Al-Mufti
- Department of Neuroendovascular Surgery and Neurocritical Care (F.A.-M.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - T Payner
- Division of Cerebrovascular Neurosurgery (T.P., C.K.), Goodman Campbell Brain and Spine, Indianapolis, Indiana.,Division of Cerebrovascular Neurosurgery (T.P., C.K.), Ascension St. Vincent's Medical Center, Indianapolis, Indiana
| | - C Kulwin
- Division of Cerebrovascular Neurosurgery (T.P., C.K.), Goodman Campbell Brain and Spine, Indianapolis, Indiana.,Division of Cerebrovascular Neurosurgery (T.P., C.K.), Ascension St. Vincent's Medical Center, Indianapolis, Indiana
| | - A DeNardo
- From the Division of Neurointerventional Radiology (K.A., D.S., A.D., J.S.).,Division of Neurointerventional Radiology (K.A., D.S., A.D., J.S.)
| | - J Scott
- From the Division of Neurointerventional Radiology (K.A., D.S., A.D., J.S.).,Division of Neurointerventional Radiology (K.A., D.S., A.D., J.S.)
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