Tandem occlusive lesions are responsible for up to 20% of acute ischemic stroke cases
and are associated with poor prognosis if complete recanalization cannot be achieved.
Endovascular recanalization might be challenging due to difficulties in the safe passage
of the occluded plaque at the origin of the internal carotid artery (ICA). The balloon-assisted
tracking technique (BAT), where a partially deflated balloon is exposed out of the
catheter tip to facilitate its passage through stenosed or spastic arterial segments
was introduced by interventional cardiologists and the applicability of the technique
has been recently proposed in the field of neurointervention as well. Here we describe
our experience using the BAT technique in the endovascular recanalization of tandem
occlusive lesions.Procedures were performed from June 2013 to December 2020 in a single
center. Baseline clinical and imaging data, procedural and follow-up details and clinical
outcomes were retrospectively collected.In this study 107 patients, median age 66
years, median admission NIHSS 14 and median ASPECTS 8 were included. Successful recanalization
of the ICA using the BAT technique was achieved in 100 (93%) and successful intracranial
revascularization in 88 (82%) patients. There were no complications attributable to
the BAT technique. Intraprocedural complications occurred in 9 (8%) patients. Emergent
stenting was performed in 40 (37%) at the end of the procedure. Postprocedural adverse
events (intracerebral hemorrhage [ICH], malignant infarction) occurred in 6 (5%) patients.
Good clinical outcome at 3 months (modified Rankin scale [mRS] 0-2) was 54 (50%) and
mortality 26 (24%). Delayed stent placement during follow-up occurred in 21 cases.Application
of BAT technique in tandem occlusions appears feasible, safe, and efficient. Further
evaluation of this technique is awaited.
