title: Combined proximal balloon occlusion and distal aspiration: a new approach to prevent distal embolization during neurothrombectomy.
abstract: OBJECTIVE
  Embolization of thrombus fragments in a new vascular territory is a potential adverse event in neurothrombectomy. This study was performed to evaluate the safety and feasibility of a novel approach combining proximal balloon occlusion and distal aspiration to prevent distal thrombembolic complications.
  
  
  METHODS
  Patients with ischemic stroke meeting the following inclusion criteria were eligible: occlusion in the anterior circulation, neurothrombectomy using a balloon catheter for proximal flow arrest, and an intermediate catheter for distal aspiration. Pre- and post-interventional Thrombolysis In Cerebral Infarction (TICI) scores were assessed. Clinical presentation at admission and discharge and after 3 months was also evaluated and complications (particularly new thrombembolic events) were recorded.
  
  
  RESULTS
  We retrospectively identified 31 patients from our prospectively collected stroke database who met the inclusion criteria. In all patients the initial TICI was 0. A TICI score of ≥2b was achieved in 96.8%. No new thrombembolic complications occurred. The median NIH Stroke Scale score was 19 at admission and 4.5 at discharge. After 3 months, 51.6% of the patients had a favorable clinical outcome (modified Rankin Scale score 0-2) and 19.3% had died.
  
  
  CONCLUSIONS
  A combination of proximal internal carotid artery occlusion using a balloon catheter and distal aspiration through an intermediate catheter represents a safe and efficient adjunct to mechanical thrombectomy with stent retrievers. In our patient cohort, no new thrombembolic complications were detected.
authors.affiliation: Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Stampfl
authors.affiliation: Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Johannes
authors.identifier: http://orcid.org/0000-0003-0672-5718
authors.initials: J
authors.lastname: Pfaff
authors.affiliation: Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Herweh
authors.affiliation: Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Mirko
authors.initials: M
authors.lastname: Pham
authors.affiliation: Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Schieber
authors.affiliation: Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ringleb
authors.affiliation: Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bendszus
authors.affiliation: Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Markus A
authors.initials: MA
authors.lastname: Möhlenbruch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion / Q000009:adverse effects / Q000379:methods*; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000628:therapy; D057785:Catheters; D003131:Combined Modality Therapy / Q000379:methods; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D020521:Stroke / Q000000981:diagnostic imaging / Q000628:therapy; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Stroke; Thrombectomy