Background In cases of
acute ischemic stroke, manual aspiration of the
thrombus is commonly performed with a balloon guiding
catheter placed in the cervical segment of the internal carotid artery (ICA). However, most manual aspirations using a balloon guiding
catheter are combined with inner
catheters, as in the direct aspiration first pass technique (ADAPT). We experienced some cases of
acute ischemic stroke with proximal ICA occlusion due to cardiogenic
thrombus where we obtained sufficient recanalization by simple manual aspiration from inflated Optimo 9F balloon
catheters (Tokai Medical Products, Japan) placed in the origin of the cervical segment of the ICA without any inner
catheter or
stent retriever. We perform by preference this procedure, named the simple Aspiration with Balloon
Catheter (simple ABC) technique. Herein, we report two recent cases and discuss this procedure. Case presentation Case 1: An 80-year-old man with
paroxysmal atrial fibrillation developed left ICA occlusion. We performed the simple ABC technique and obtained a large amount of dark red and white
thrombus.
Puncture-to-reperfusion time was 14 minutes with Thrombolysis in
Cerebral Infarction (TICI) grade 3. Case 2: A 69-year-old man with chronic
atrial fibrillation developed left internal carotid occlusion. We performed the simple ABC technique and obtained a large amount of dark red
thrombus.
Puncture-to-reperfusion time was 15 minutes with TICI grade 2b. Conclusion The simple ABC technique is useful to deal with a large amount of
thrombus, shortens procedure time, enables less invasive
thrombectomy, and can shift immediately to subsequent procedures such as delivering a
stent retriever or ADAPT.