Clinical Efficacy and Safety of a Treatment Strategy for Acute Carotid Tandem Lesions: Balloon Bridge-Blind Aspiration.

Abstract

For acute carotid tandem lesions (TLs), the optimal endovascular therapy strategy is still debatable. This study reports a single-center experience treating acute carotid TLs using the Balloon Bridge-Blind Aspiration (BBBA) treatment strategy. We assessed the efficacy and safety of the BBBA treatment strategy. We conducted a retrospective analysis of patients admitted to the Department of Neurology at Jining First People's Hospital from January 2019 to December 2024. These patients were all treated with the BBBA treatment strategy for acute carotid TLs. Clinical data and imaging data were analyzed retrospectively. Efficacy was assessed by the rate of successful recanalization (modified Thrombolysis in Cerebral Infarction=2 b/3) and the 90-day favorable outcome (modified Rankin Scale score of 0-2). Safety was evaluated by the occurrence of symptomatic intracranial hemorrhage and mortality at 90 days. The study included 83 patients with acute carotid TLs. Their median age was 67 years (interquartile range [IQR], 60-72 years), and the median National Institutes of Health Stroke Scale score at admission was 16 (IQR, 12-18). The median time from symptom onset to groin puncture was 270 minutes (IQR, 200-330 minutes). The median time from groin puncture to first recanalization was 50 minutes (IQR, 40-70 minutes), and the median operative time was 70 minutes (IQR, 60-90 minutes). Among the patients, 25.3% required the rescue technique, and 21.7% underwent acute stenting. Successful recanalization was achieved in 75 patients (90.4%). The rate of a favorable clinical outcome was 60.2%, the rate of symptomatic intracranial hemorrhage was 8.4%, and the mortality was 9.6%. The BBBA treatment strategy may be a safe and effective treatment strategy for acute carotid TLs, improving patient outcomes and reducing the usage rate of acute stents.