Walrus Balloon Guide Catheter for Stroke Intervention: Technical Considerations and Clinical Outcomes

Rimal H Dossani; Muhammad Waqas; Ammad A Baig; Justin M Cappuzzo; Daniel Popoola; Hamid Rai; Andre Monteiro; Aaron Levy; Eisa Hashmi; Jason M Davies; Elad I Levy; Adnan H Siddiqui

doi:10.1016/j.wneu.2021.05.051

Walrus Balloon Guide Catheter for Stroke Intervention: Technical Considerations and Clinical Outcomes

World Neurosurg. 2021 Aug:152:e144-e148. doi: 10.1016/j.wneu.2021.05.051. Epub 2021 May 24.

Authors

Affiliations

¹ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
² Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA.
³ University of California Santa Barbara, Santa Barbara, California, USA.
⁴ Canisius College, Buffalo, New York, USA.
⁵ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, State University of New York at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA.
⁶ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, State University of New York at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA.
⁷ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; University of California Santa Barbara, Santa Barbara, California, USA; Jacobs Institute, Buffalo, New York, USA. Electronic address: [email protected].

PMID: 34033957
DOI: 10.1016/j.wneu.2021.05.051

Abstract

Background: The use of balloon guide catheters (BGCs) for proximal flow arrest during neurointerventional procedures has been limited owing to the incompatibility of BGCs with large-bore aspiration catheters and difficulty in device navigation. The objective of our study was to describe the use of the Walrus catheter (Q'Apel Medical, Fremont, California, USA), a new 8F BGC, with a variety of aspiration catheters and procedures requiring flow arrest.

Methods: Consecutive cases using Walrus BGCs for proximal flow arrest during mechanical thrombectomy for acute stroke cases were recorded. The procedure indication, vessel occlusion site, technique, first-pass effect (modified thrombolysis in cerebral infarction score of 2C or 3 after the first recanalization attempt), and complications were recorded and evaluated statistically.

Results: Our study included 57 patients who had undergone mechanical thrombectomy. In addition to mechanical thrombectomy, the Walrus BGC was used in conjunction with the following techniques: stent retrieval in 2 patients (3.5%), stent retrieval followed by aspiration (Solumbra technique) in 41 (71.9%), and aspiration followed by stent retrieval in 14 patients (24.6%). Eight different aspiration catheters were used in 56 of these 57 procedures. The first-pass effect (modified thrombolysis in cerebral infarction score of 2C and 3) was achieved in 36 (63.2%) of 57 procedures. Two patients (3.5%) had experienced intraoperative complications (symptomatic intracerebral hemorrhage) and one patient (1.8%) had died in-hospital.

Conclusions: Our results have demonstrated that the Walrus BGC is a highly navigable 8F guide catheter compatible with most available aspiration catheters. Owing to its compatibility with most available aspiration catheters and ease of use, the Walrus BGC is a valuable addition to the tools available for mechanical thrombectomy.

Keywords: Balloon guide catheter; Mechanical thrombectomy; Proximal flow arrest; Walrus catheter.

MeSH terms

Aged
Aged, 80 and over
Balloon Embolectomy / instrumentation
Balloon Embolectomy / methods*
Brain Ischemia / diagnosis
Brain Ischemia / surgery*
Female
Humans
Male
Mechanical Thrombolysis / instrumentation
Mechanical Thrombolysis / methods*
Middle Aged
Retrospective Studies
Stroke / diagnosis
Stroke / surgery*
Treatment Outcome