Abstract
IntroductionThe 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).MethodsProspectively maintained databases at 9 North-American Centers were queried to identify patients with cervical carotid disease undergoing eCAS/tCAS with Walrus BGC.Results110 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 monitored anesthesia care (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).Abstract E-006 Table 1Comparison of elective carotid stenting with/without distal protection Variable Distal Protection 51 (63.8%) Without Distal Protection 29 (36.2%) p-Value Age at time of treatment Years; (median; IQR) 68 (59 - 76) 68 (62 - 76) 0.56 Gender Female 13 (25.5%) 18 (62.1%) 0.001 Male 38 (74.5%) 11 (37.9%) Smoking history Never smokers 18 (35.3%) 15 (51.7%) 0.34 Past smokers 11 (21.6%) 4 (13.8%) Current smokers 22 (43.1%) 10 (34.5%) Cardiac comorbidities history 27 (52.9%) 6 (20.7%) 0.005 Prior treatment history None 48 (94.1%) 28 (96.6%) 0.63 Yes (CEA/CAS) 3 (5.9%) 1 (3.5%) Access Femoral 45 (88.2%) 29 (100%) 0.06 Wrist 6 (11.8%) 0 (0%) Presence of carotid challenges 1 (2%) 2 (6.9%) 0.26 Presence of aortic arch challenges 9 (17.7%) 12 (41.4%) 0.02 Atherosclerotic lesions nature 44 (88%) 23 (79.3%) 0.3 CCA diameter (mm median; IQR) 6.6 (6.2–7.1) 6.7 (6.1–7.3) 0.82 ICA diameter (post-lesion) (mm median; IQR) 4.2 (3.7–4.9) 4.2 (3.8–4.6) 0.9 Presence of contralateral stenosis 29 (56.9%) 8 (27.6%) 0.012 Contralateral stenosis% (median; IQR) 50 (45–80) 65 (42.5–99.5) 0.72 Platelet function tests 48 (94.1%) 24 (82.8%) 0.1 P2Y12 at day of procedure (median; IQR) 120 (60–155) 105 (54–186) 0.29 Pre-stent deployment angioplasty 18 (36%) 14 (50%) 0.23 Post-stent deployment angioplasty 25 (50%) 20 (71.4%) 0.07 Outcomes Peri-procedural ischemic complications 0 (0%) 0 (0%) >0.99 Remote ischemic complications 1 (2%) 1 (3.4%) 0.63 Hemorrhagic complications 0 (0%) 0 (0%) >0.99 Retreatment 3 (6.8%) 1 (4.4%) 0.69 ConclusionWalrus 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.Disclosures M. Salem: None. S. Kvint: None. A. Baig: None. A. Monteiro: None. G. Cortez: None. A. Luisa Kuhn: None. O. Goren: None. S. Dalal: None. B. Jankowitz: None. O. Choudhri: None. D. Raper: None. O. Tanweer: None. P. Jabbour: None. R. Starke: None. E. Levy: None. C. Griessenauer: None. A. Puri: None. R. Hanel: None. A. Siddiqui: None. J. Burkhardt: None.