Safety and feasibility of transradial use of 8F balloon guide catheter Flowgate2 for endovascular thrombectomy in acute ischemic stroke

2021 ◽  
pp. 159101992110131
Author(s):  
Mario Martínez-Galdámez ◽  
Miguel Schüller ◽  
Jorge Galvan ◽  
Mercedes de Lera ◽  
Vladimir Kalousek ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Vascular Anatomy ◽  
High Rate ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
Patient Demographics ◽  
Guide Catheter ◽  
Successful Approach ◽  
And Performance ◽  
Type 3

Background While Balloon Guide Catheters (BGC) have been shown to increase the rate of reperfusion during mechanical thrombectomy (MT), its implementation with transfemoral approach is at times limited due to unfavorable vascular anatomy. Objective to determine safety, feasibility and performance of the transradial use of 8 F BGC Flowgate 2 during mechanical thrombectomy procedures in patients with unfavorable vascular anatomies (type 3 or bovine arch) Material/Methods: We performed a retrospective cohort study of consecutive transradial mechanical thrombectomies performed with BGC Flowgate 2 between January and December 2019. Patient demographics, procedural and radiographic metrics, and clinical data were analyzed. Results 20 (8.7%) out of 230 overall thrombectomy procedures underwent transradial approach using an 8 F BGC Flowgate. 2 Successful approach was achieved in 17/20 cases, and in 3 cases radial was switched to femoral, after failure. TICI 2 C/3 was achieved in 18 cases (90%), followed by TICI 2 b and 2a in 1 (5%) case respectively. The average number of passes was 1.8. The average radial puncture-to-first pass time was 22 min. Radial vasospasm was observed in 3/20 cases. The Flowgate 2 was found kinked in 4/20 cases (20%), all of them during right internal carotid procedures. There were no postprocedural complications at puncture site, as hematoma, pseudoaneurysm or local ischemic events Conclusion The use of 8 F Balloon Guide Catheter during MT via transradial approach might represent an alternative in selected cases with unfavorable vascular anatomies. Its use in right ICA catheterizations was associated with a high rate of catheter kinking.

Balloon anchoring technique for thrombectomy in hostile craniocervical arterial anatomy

2020 ◽  
Vol 12 (8) ◽  
pp. 763-767
Author(s):  
Vera Sharashidze ◽  
Raul G Nogueira ◽  
Alhamza R Al-Bayati ◽  
Jonathan A Grossberg ◽  
Diogo C Haussen
Keyword(s):  
Aortic Arch ◽  
Vascular Anatomy ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Guide Catheter ◽  
Procedural Time ◽  
Type 3 ◽  
Arterial Anatomy ◽  
Anchoring Technique

BackgroundCraniocervical catheter access in large vessel occlusion acute ischemic strokes can be challenging in cases of unfavorable aortic arch/cervical vascular anatomy, leading to lower recanalization rates, increased procedural time and worse clinical outcomes. We aim to demonstrate the feasibility of the balloon-anchoring technique (BAT) that can be attempted before switching to alternative access sites.MethodsRetrospective review of prospectively collected information on 11 patients in which two variants of the BAT (proximal anchoring: balloon guide catheter (BGC) is inflated to provide support for distal access; distal anchoring: compliant balloon is inflated in an intracranial artery to allow advancement of the support system) were utilized to facilitate craniocervical access due to failure of conventional maneuvers.ResultsTen patients had anterior and one patient had posterior circulation large vessel occlusions. Mean age was 81 years and 81% were females. Type 3 arches were found in 82% and a 9 French balloon guide catheter was used in 82%. Proximal anchoring with BGC was used in four cases while distal anchoring was used in seven patients to allow access to the target vessel, avoiding the need to puncture alternative access sites. Successful reperfusion (modified treatment in cerebral ischemia 2b-3) was achieved in all cases and no complications were observed.ConclusionBAT is safe and feasible. It can be considered as a rescue maneuver in order to avoid switching to a different access during thrombectomy in individuals with unfavorable aortic arch/craniocervical anatomy.

scholarly journals TRANSRADIAL APPROACH FOR CAROTID ARTERY STENTING

2018 ◽  
Vol 7 (4) ◽  
pp. 112-120
Author(s):  
D. U. Malaev ◽  
E. I. Kretov ◽  
V. I. Baystrukov ◽  
A. A. Prokhorikhin ◽  
A. A. Boykov
Keyword(s):  
Coronary Artery ◽  
Carotid Artery ◽  
Aortic Arch ◽  
Carotid Artery Stenting ◽  
Vascular Complications ◽  
Good Alternative ◽  
High Rate ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
Coronary Artery Stenting

Approximately 20% of ischemic strokes are provoked by stenotic carotid artery lesions. With the growing experience of surgeons and the continued improvement of devices, carotid artery stenting has become an effective alternative to carotid endarterectomy. Traditional access to carotid artery stenting is transfemoral approach. However, due to peripheral artery disease and challenging anatomy of the aortic arch, transfemoral approach may be problematic. A number of randomized trials have proven the effcacy and safety of transradial access for coronary interventions. A similar technique was adapted for coronary artery stenting. The article provides a review of the major studies dedicated to coronary artery stenting via transradial approach, discusses all benefts and limitations as well as provide the guide to select an optimal vascular access, depending on the patient's anatomical characteristics. Transradial approach is shown to be a good alternative to transfemoral approach for coronary artery stenting. However, it is accompanied by a high rate of unsuccessful procedures compared to transfemoral approach. Nevertheless, transradial approach is accompanied by a decrease in the rate of vascular complications, and is preferable for intervening on the right ICA, or on the left with bovine aortic arch.

scholarly journals Distal transradial access in the anatomical snuffbox for diagnostic cerebral angiography

2019 ◽  
Vol 11 (7) ◽  
pp. 710-713 ◽  
Author(s):  
Marie-Christine Brunet ◽  
Stephanie H Chen ◽  
Samir Sur ◽  
David J McCarthy ◽  
Brian Snelling ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cerebral Angiography ◽  
Hospital Costs ◽  
Artery Occlusion ◽  
Patient Comfort ◽  
Complication Rates ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
Access Site Complication ◽  
Patient Demographics

BackgroundThe transradial approach for endovascular angiography and interventional procedures is superior to the traditional transfemoral approach in several metrics, including lower access-site complication rates, higher patient satisfaction, and lower hospital costs. Interventional cardiologists have begun to adopt the distal transradial approach (dTRA) for coronary interventions as it has an improved safety profile and improved procedural ergonomics. Adaptation of dTRA for neuroendovascular procedures promises similar benefit, but requires a learning curve.ObjectiveTo report the first use of dTRA for diagnostic cerebral angiography and demonstrate the feasibility and safety of a dTRA.MethodsA retrospective review of our prospective institutional database of consecutive cases of cerebral DSA performed via dTRA between August 2018 and December 2018 was performed. Patient demographics, procedural and radiographic metrics, and clinical data were recorded.Results85 patients were identified with an average age of 53.8 years (range 18–82); 67 (78.8%) patients were female. 78 patients underwent successful dTRA diagnostic cerebral angiography, with a mean of five vessels catheterized and average fluoroscopy time of 12.0 min, or 2.6 min for each vessel. Seven patients required conversion to transfemoral access, with the most common reason being inability to advance the wire and radial artery spasm. There were no complications.ConclusiondTRA is associated with decreased rates of radial artery occlusion, ischemic hand events, as well as improved patient comfort, faster periprocedural management, and cost benefits. Our preliminary experience with dTRA for diagnostic cerebral angiography demonstrates excellent feasibility and safety in combination with relative efficiency.

Upgrading Wastewater Treatment Plants with Anaerobic Selectors

1990 ◽  
Vol 22 (7-8) ◽  
pp. 35-43
Author(s):  
K. D. Tracy ◽  
S. N. Hong
Keyword(s):  
Phosphorus Removal ◽  
Wastewater Treatment Plants ◽  
Full Scale ◽  
High Rate ◽  
Nitrogen Control ◽  
Biological Phosphorus Removal ◽  
Conventional Activated Sludge ◽  
And Performance ◽  
Activated Sludge Processes ◽  
Biological Phosphorus

The anaerobic selector of the A/0™ process offers many advantages over conventional activated sludge processes with respect to process performance and operational stability. This high-rate, single-sludge process has been successfully demonstrated in full-scale operations for biological phosphorus removal and total nitrogen control in addition to BOD and TSS removal. This process can be easily utilized in upgrading existing treatment plants to meet stringent discharge limitations and to provide capacity expansion. Upgrades of two full-scale installations are described and performance data from the two facilities are presented.

scholarly journals Design and performance of SiPM-based readout of PbF2 crystals for high-rate, precision timing applications

2017 ◽  
Vol 12 (01) ◽  
pp. P01009-P01009 ◽  
Author(s):  
J. Kaspar ◽  
A.T. Fienberg ◽  
D.W. Hertzog ◽  
M.A. Huehn ◽  
P. Kammel ◽  
...  
Keyword(s):  
High Rate ◽  
And Performance

Mechanical thrombectomy for anterior circulation stroke: 5-year experience in a statewide service with differences in pretreatment time metrics across two hospitals sites

2016 ◽  
Vol 9 (6) ◽  
pp. 535-540 ◽  
Author(s):  
Ruchi Kabra ◽  
Timothy J Phillips ◽  
Jacqui-Lyn Saw ◽  
Constantine C Phatouros ◽  
Tejinder P Singh ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Stroke Onset ◽  
Anterior Circulation ◽  
Stroke Treatment ◽  
Patient Demographics ◽  
Organizational Differences ◽  
Tertiary Hospitals ◽  
Pretreatment Time

ObjectiveTo audit our institutional mechanical thrombectomy (MT) outcomes for acute anterior circulation stroke and examine the influence of workflow time metrics on patient outcomes.MethodsA database of 100 MT cases was maintained throughout May 2010—February 2015 as part of a statewide service provided across two tertiary hospitals (H1 and H2). Patient demographics, stroke and procedural details, blinded angiographic outcomes, and 90-day modified Rankin Scale (mRS) scores were recorded. The following time points in stroke treatment were recorded: stroke onset, hospital presentation, CT imaging, arteriotomy, and recanalization. Statistical analysis of outcomes, predictors of outcome, and differences between the hospitals was carried out.ResultsThrombolysis in Cerebral Infarction (TICI) 2b/3 reperfusion was 79%. Forty-nine per cent of patients had good clinical outcomes (mRS 0–2). In a subgroup analysis of 76 patients with premorbid mRS 0–1 and first CT performed ≤4.5 h after stroke onset, 60% had good clinical outcomes. Patient and disease characteristics were matched between the two hospitals. H1 had shorter times between hospital presentation and CT (32 vs 55 min, p=0.01), CT and arteriotomy (33 vs 69 min, p=0.00), and stroke onset and recanalization (198 vs 260 min, p=0.00). These time metrics independently predicted good clinical outcome. Median days spent at home in the first 90 days was greater at H1 (61 vs 8, p=0.04) than at H2. A greater proportion of patients treated at H1 were independent (mRS 0–2) at 90 days (54% vs 42%); however, this was not statistically significant (p=0.22).ConclusionsOutcomes similar to randomized controlled trials are attainable in ‘real-world’ settings. Workflow time metrics were independent predictors of clinical outcome, and differed between the two hospitals owing to site-specific organizational differences.

Abstract WP18: Cerebral Mechanical Thrombectomy Simulator Using Hydrogel Polymers and 3D Printing Technology

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Timothy Campbell ◽  
Jonathan Stone ◽  
Arun Parmar ◽  
Edward Vates ◽  
Amrendra Miranpuri
Keyword(s):  
3D Printing ◽  
Mechanical Thrombectomy ◽  
Low Cost ◽  
Cerebral Arteries ◽  
Critical Time ◽  
Training Experience ◽  
Printing Technology ◽  
Stroke Treatment ◽  
3D Printing Technology ◽  
Guide Catheter

Introduction: While stroke remains a leading cause of death and disability, recent advances in endovascular technology an important opportunity to make a significant impact in clinical outcomes. However, training opportunities are rare, preventing dissemination of these techniques. Hands-on training is further complicated by the critical time to therapy associated with stroke treatment. This physical simulator was built for neurosurgical residents and fellows to practice mechanical thrombectomy. Methods: A simplified virtual model of the anterior cerebral circulation was created based on patient imaging. This luminal model was 3D printed using flexible filament and attached to a guide catheter at the proximal carotid to provide endovascular access and an IV tube at the distal M2 branches to permit outflow. A 7Fr sheath was also connected at the anterior cerebral artery to permit placement of a simulated clot model and simulate a proximal M1 occlusion. This entire construct was placed into a container of polyvinyl alcohol (PVA) and after crosslinking the flexible print was removed. Results: Using 3D printing technology and polymer hydrogels, a low-cost, high fidelity stroke model was achieved. Despite its simplified anatomy, the model permitted realistic wire and catheter navigation through the different segments of the internal carotid and middle cerebral arteries. The ACOM sheath provided a convenient method to reliably place an embolism and created a life-like proximal M1 occlusion. Recanalization was performed using the solumbra technique, which is used in live-patient cases. Conclusions: This model demonstrated proof of concept for a mechanical thrombectomy simulation. The angiographic profile and response to endovascular tools created a training experience similar to live endovascular procedures. As the model is perfected visually and mechanically, next steps are to perform validation studies and create a training curriculum.

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