Use of a sheathless 8-French balloon guide catheter (Walrus) through the radial artery for mechanical thrombectomy: technique and case series.

Abstract

BACKGROUND:

The effectiveness of transradial stroke thrombectomy has been limited by guide catheter size and lack of good balloon options. In this study we describe our technique for the use of a sheathless 8-French balloon guide catheter (Walrus) through radial access and present our initial clinical experience.

METHODS:

This was a retrospective case series of consecutive patients who underwent mechanical thrombectomy for large vessel occlusion using the sheathless catheter over a period of 3 months. Clinical characteristics, procedural details, reperfusion success (modified Thrombolysis in Cerebral Infarction (mTICI) 2b-3 grade), first-pass effect (FPE; mTICI reperfusion grade 2c or 3 with a single pass), access site complications and clinical improvement at discharge were recorded. A descriptive analysis was performed.

RESULTS:

Among the 10 patients in the series, median age was 77 years (IQR 75-79) and three were women. All patients had a baseline modified Rankin Scale score ≤2. Median admission National Institutes of Health Stroke Scale (NIHSS) score was 12.5 (IQR 9-16). Four patients received intravenous alteplase before mechanical thrombectomy. Eight patients had M1 occlusion and two had proximal M2 occlusion. The median radial artery diameter was 2.5 mm (IQR 2.5-2.7). Successful reperfusion was achieved in all patients. FPE was achieved in six patients. No access site-related complications or post-procedural intracranial hemorrhages occurred. All patients had improvement in NIHSS score at discharge.

CONCLUSIONS:

The use of this sheathless catheter for transradial access was safe and feasible. The technique can potentially improve the outcomes of transradial access for stroke intervention.

• Authors: Rimal H Dossani, Muhammad Waqas, Andre Monteiro, Justin M Cappuzzo, Faisal Almayman, Kenneth V Snyder, Elad I Levy, Adnan H Siddiqui, Jason M Davies
• Journal: Journal of neurointerventional surgery (J Neurointerv Surg) Vol. 14 Issue 5 (May 2022) ISSN: 1759-8486 [Electronic] England
• PMID: 34429347 (Publication Type: Journal Article)
• Copyright: © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Animals
• Brain Ischemia
• Catheters
• Female
• Humans
• Radial Artery (surgery)
• Retrospective Studies
• Stroke (diagnostic imaging, surgery)
• Thrombectomy (methods)
• Treatment Outcome
• Walruses