The 'Slingshot' technique: balloon-guide assisted tracking of distal systems past tortuosity and ledges in thrombectomy.

Abstract

We describe and analyze a novel technique by which inflation of a proximal balloon guide catheter (BGC) permits tracking of distal catheter systems past vessel tortuosity and ledges like the ophthalmic segment of the internal carotid artery (ICA). Inflation of the BGC counteracts slippage when deployed, and careful advancement of the system builds up energy that is translated forward, allowing users to cross segments otherwise inaccessible by endovascular techniques. A retrospective review of our institutional neurovascular database was conducted, and we identified nine patients for whom the novel 'Slingshot' technique was used for mechanical thrombectomy. Patient characteristics, outcomes, and procedural steps were collected and analyzed with regards to safety and efficacy of the technique. The Slingshot technique was successful in all nine cases to navigate the distal system to the target location. For all cases, conventional tracking of the catheter failed, and the Slingshot technique was used as a rescue. No intraoperative complications such as vessel dissection or perforation were observed. First pass recanalization was achieved in seven (78%) cases with successful reperfusion (thrombolysis in cerebral infarction ((TICI) ≥2B) in all cases. Patient outcome was favorable with National Institutes of Health Stroke Scale (NIHSS) score improvement from a median of 16 to 3 postoperatively. For neurovascular procedures in which advancement of an intermediate catheter or other equipment is limited by ledges or tortuosity, the Slingshot technique is a safe and effective way to reach the intended target position and does not require additional catheters or devices.