Novel Technique of Stent Placement via Gateway Balloon in Intracranial Atherosclerosis-associated Large Vessel Occlusion
Rowaid Ahmad1, Muhammad Memon1, Mohamad Ezzeldin2, Arundhati Biswas3, Taha Nisar4, Amit Singla4, Nazar Muhammad5, Hashem Shaltoni1, Peter Kan1, Osama Zaidat6, Priyank Khandelwal7
1University of Texas Medical Branch Glaveston, 2Rush University Medical Center, 3Carle Foundation Hospital, 4Rutgers New Jersey Medical School, 5Cornerstone Family Healthcare, 6St Vincent Mercy Hospital, 7Rutgers, The State University of New Jersey
Objective:
To present our initial experience of deploying Neuroform Atlas stent directly via Gateway Balloon Catheter in intracranial atherosclerosis disease-associated large vessel occlusions (ICAD-LVO).
Background:
The Food and Drug administration (FDA) approved Wingspan Stent used in ICAD-LVO cases requires micro catheter exchange maneuver which is associated with complications such as intracranial hemorrhage (ICH). Neuroform Atlas stent can be deployed directly via Gateway Balloon for angioplasty and stent placement without the need for exchange maneuver, potentially reducing the risk of complications due to vascular trauma.
Design/Methods:
Patients were identified through mechanical thrombectomy database from January 2020 to June 2022 at our institutions. Due to reocclusion or impending occlusion, rescue angioplasty with stent placement was performed after initial standard MT. Primary outcomes were good angiographic recanalization with modified thrombolysis in cerebral infarction (mTICI) score of 2b-3, rate of intracranial hemorrhage (ICH), and favorable functional outcome at 3 months, that is, modified Rankin Scale (mRS) score of 0-3.
Results:
We identified 22 patients treated using this technique. Among those, 11 were females with their average age at 66 years (range: 52-85). Initial median National Institute of Health Stroke Scale score was 11 (range: 5-30) and all patients received loading doses of aspirin and P2Y₁₂ inhibitor. After performing submaximal angioplasty and Neuroform Atlas stent deployment through the gateway balloon, we achieved final mTICI of 2b-3 in 20 (90%) patients. One patient had ICH post-op that was asymptomatic. Eight (36%) patients had mRS of 0-3 at 90 days.
Conclusions:
Our preliminary experience suggests possible safety and feasibility of deploying Neuroform Atlas stent through a compatible Gateway Balloon Catheter without the need for ICH-associated micro catheter exchange. Multi-center prospective clinical trials with long-term clinical and angiographic follow-up are warranted to confirm this favorability.