Abstract
Introduction
: The Walrus Balloon Guide Catheter (BGC) is a new generation of BGC, designed to eliminate conventional BGC limitations during mechanical thrombectomy (MT). We report a multi‐institutional experience using this BGC for proximal flow‐control (PFC) in the setting of carotid artery angioplasty/stenting (CAS) in elective (eCAS) and tandem strokes (tCAS).
Methods
: Prospectively maintained databases at 7 North‐American Centers were queried to identify patients with cervical carotid disease undergoing eCAS/tCAS with Walrus BGC.
Results
: 110 patients (median age 68, 64.6% males) undergoing 80 eCAS (72.7%) and 30 tCAS (27.3%) procedures were included (median cervical carotid stenosis 90%; 41.8% with contralateral stenosis). Utilizing proximal flow‐arrest technique in 87.2% and flow‐reversal in 12.8% of procedures, the Walrus was navigated into the common carotid artery (CCA) successfully in all cases despite challenging arch anatomy (28.2%), with preferred femoral access (93.6%) and in conscious sedation (81.8%). Angioplasty and distal embolic protection devices (EPD) were used in 83.7% and 52.7% of procedures, respectively. tCAS led to a mTICI 2b/3 in all cases. Periprocedural ischemic stroke (till 30‐days post‐operatively) rate was 0.9% and remote complications occurred in 1.8% of the cases. Last follow‐up mRS of 0–2 was seen in 95.3% of eCAS cohort, with no differences in complications in the eCAS subgroup between PFC only versus PFC and distal EPD (median follow‐up 4.1 months).
Conclusions
: Walrus BGC for proximal flow‐control is safe and effective during eCAS and tCAS. Procedural success was achieved in all cases, with favorable safety and functional outcomes on short term follow‐up.