The ATTAIN Technique (Amplatz lefT guiding caTheter pArtIal deploymeNt): An Alternative Approach for Transradial Stenting of Low-Origin Vertebral Artery Ostial Stenosis.
Aug 2026· World Neurosurgery· pp.
125262
· 0 citations
Medicine
TL;DR
The ATTAIN technique showed preliminary feasibility and provided a standardized AL guiding catheter-assisted deployment sequence for selected right-sided low-origin VAOS, and provided a standardized AL guiding-catheter-assisted deployment sequence for selected right-sided low-origin VAOS.
Abstract
Objective
To assess technical feasibility and procedural features of the Amplatz Left (AL) guiding catheter-assisted partial deployment (ATTAIN) technique for selected right-sided low-origin vertebral artery ostial stenosis (VAOS).
Methods
We prospectively studied 10 consecutive patients. Technical success required accurate balloon-expandable drug-eluting stent placement and expansion without access crossover, guide-catheter exchange, or salvage techniques. Safety outcomes included 30-day neurological and access-site events and follow-up stent-related events. Preprocedural assessment considered vertical ostial depth (VOD) and subclavian-vertebral geometry.
Results
During the 17-month enrollment period, technical success was achieved in 9 of 10 patients (90%). Median age was 71.5 years (IQR, 69-74); median VOD was 12.5 mm (IQR, 11-16). Among successful procedures, median deployment time was 28 minutes (IQR, 22-32). Median stenosis decreased from 76.5% (IQR, 73%-83%) to 2.5% (IQR, 0%-9%). At 3 months, symptoms completely resolved in 6 patients, partially improved in 2, and remained unchanged in 2; all had modified Rankin Scale scores of 0 or 1. No clinically apparent stroke, transient ischemic attack, or death occurred within 30 days; one unconfirmed minor access-site event was recorded. At a median 8-month follow-up (IQR, 5-11; range, 3-15), 9 patients underwent imaging, no stent fracture or in-stent restenosis was identified.
Conclusions
In this proof-of-concept series, the ATTAIN technique showed preliminary feasibility and provided a standardized AL guiding-catheter-assisted deployment sequence for selected right-sided low-origin VAOS. Comparative efficacy, definitive safety, and left-sided applicability remain unestablished.
Background Endovascular recanalization of non-acute internal carotid artery occlusion (NA-ICAO) remains technically challenging. This technical report describes the Balloon-Assisted Catheter Advancement (BACAT) technique and evaluates its procedural feasibility in a small, heterogenous patient cohort. Methods We retrospectively reviewed 15 patients with NA-ICAO who underwent BACAT-assisted recanalization. Cases included both pure endovascular therapy (n = 8) and hybrid therapy combined open surgery with endovascualr therapy (n = 7). The primary outcome was technical success, defined as successful antegrade passage of the catheter across the occlusive segment using the BACAT maneuver. Procedural complications were recorded descriptively. Results Technical success was achieved in 13 of 15 patients (86.7%). No intraprocedural rupture or flow-limiting dissection occurred. One non-disabling postoperative stroke (6.7%) was observed in the hybrid subgroup. Given the small sample, absence of a control group, and case heterogeneity, no statistical comparisons or efficacy claims are made. Conclusions The BACAT technique appears technically feasible for selected patients with NA-ICAO, including both pure endovascular therapy and hybrid surgical. This report provides procedural details to facilitate replication and further investigation. Clinical efficacy and comparative safety require validation in larger, controlled studies.
Yufeng Wang, Yixin Sun, Ruilin Ren et al.· Frontiers in Surgery· 0 citations
While temporary stent retriever deployment (TSRD) is an increasingly utilized option for intracranial atherosclerotic disease-related large vessel occlusion (ICAD-LVO), standardized criteria to guide the intraprocedural decision between device retrieval, resheathing, and rescue therapies remain undefined. We systematically evaluated real-time angiographic signs to guide this decision-making process. We retrospectively reviewed consecutive patients with ICAD-LVO treated using TSRD at 2 centers. Two angiographic signs were operationalized: the instent thrombotic sign (IST), representing intra-stent filling defects observed during dwell time; and post-resheathing distal flow deterioration (PR-DFD), defined as a temporal reduction in distal opacification after resheathing compared to maximal deployment. The primary outcome was acute procedural success, defined as successfully maintaining target lesion patency. Secondary outcomes included final successful reperfusion (modified Thrombolysis in Cerebral Infarction, mTICI 2b-3), early neurological deterioration (END), and symptomatic intracranial hemorrhage (sICH). Eight patients were included. IST was observed in 3 patients, prompting immediate stent retrieval. In the remaining 5 patients without IST, the device was resheathed; among this subset, PR-DFD occurred in 3. Regarding the primary outcome, acute procedural success was achieved in all 8 patients, although 1 patient with PR-DFD required rescue angioplasty for early reocclusion. Notably, END occurred exclusively in the 2 patients with PR-DFD who did not undergo rescue angioplasty. Secondarily, all patients ultimately achieved final mTICI 2b-3 without sICH. These preliminary observations suggest that IST and PR-DFD may provide practical angiographic cues reflecting thrombotic burden and hemodynamic instability during TSRD.
Yukishige Hashimoto, Fusao Ikawa, T. Hidaka et al.· Neurointervention· 0 citations
PURPOSE
To report real-world outcomes of a safety-oriented, endovascular-first strategy for proximal atherosclerotic subclavian artery chronic total occlusion (CTO) and to develop a pragmatic computed tomography angiography (CTA)-based open-first consideration aid for anatomically unfavorable cases.
MATERIALS AND METHODS
This single-center retrospective study included consecutive patients treated between January 2020 and December 2024. Endovascular-first revascularization was pursued when feasible, with bypass used as primary therapy or after failed endovascular attempts. Computed tomographic angiography morphology was assessed using prespecified definitions. Factors associated with endovascular technical success were evaluated using logistic regression. Hemodynamically significant restenosis during follow-up was defined as recurrence or progression of inter-arm systolic blood pressure difference ≥20 mm Hg relative to the post-discharge baseline. Time-to-event outcomes were assessed using Kaplan-Meier analysis. A CTA-based open-first consideration score (0-4) was derived among patients undergoing definitive revascularization (bypass vs successful endovascular repair).
RESULTS
Among 122 patients, endovascular-first treatment was attempted in 101, with technical success in 75 (74.3%); definitive revascularization was achieved in 112 patients (91.8%) after inclusion of bypass. Right-sided laterality, absent proximal stump (<3 mm), and severe calcification were independently associated with endovascular technical failure. Periprocedural morbidity was low, with no clinically apparent stroke or transient ischemic attack; 1 localized type B aortic injury after endovascular repair and 1 lymphatic leak after bypass were managed conservatively. During a median follow-up of 26 months, estimated restenosis was approximately 10% at 1 year and 22% at 3 years, whereas clinically driven reintervention remained low at approximately 3% and 6%, respectively. The CTA-based open-first consideration score showed good discrimination for bypass selection (area under the curve, 0.887), with ≥2 points serving as a high-specificity prompt for bypass consideration.
CONCLUSIONS
In proximal subclavian CTO, a safety-oriented endovascular-first strategy achieved acceptable technical success, low clinically apparent neurologic morbidity, and low reintervention during mid-term follow-up. A CTA-based open-first consideration score may help identify anatomically unfavorable cases for bypass consideration and define escalation boundaries, and warrants external validation.Clinical ImpactThis study supports a safety-oriented, endovascular-first approach for proximal subclavian artery chronic total occlusion, while emphasizing that endovascular and surgical revascularization should be considered complementary rather than competing strategies. Preprocedural CTA can identify anatomically unfavorable lesions in which prolonged endovascular escalation may reduce the procedural safety margin. The proposed CTA-based open-first consideration score provides a simple framework to support treatment planning, patient counseling, and predefined stopping boundaries. Clinically, this approach may help operators avoid unnecessarily aggressive recanalization attempts while preserving endovascular therapy for patients with favorable anatomy.
Tao Shi, Jie Fang, Mingyao Luo et al.· Journal of Endovascular Ther...· 0 citations
Balloon guide catheters (BGCs) have demonstrated benefits in mechanical thrombectomy (MT) for acute ischemic stroke (AIS), including improved recanalization rates and reduced distal embolization. The EMBOGUARD™ balloon guide catheter (Johnson & Johnson Neurovascular, Irvine, CA) represents a novel design with enhanced flexibility and compatibility with large-bore aspiration catheters. This study aims to evaluate the safety and efficacy of the EMBOGUARD™ BGC compared with non-BGC approaches.
We conducted a retrospective multicenter study to analyze patients with AIS due to anterior large vessel occlusions (LVOs) who underwent MT between January 2022 and December 2024. Patients were divided into two groups: those treated with t☺he EMBOGUARD™ BGC and those treated without BGC. Primary outcomes included first-pass effect (FPE), successful recanalization (mTICI ≥2b), procedural time, number of passes, and distal embolization. Secondary outcomes included 90-day functional outcome (modified Rankin Scale [mRS] 0–2), mortality, and symptomatic intracranial hemorrhage (sICH).
A total of 178 patients were included (EMBOGUARD:
n
= 135, 75.8%; non-BGC:
n
= 43, 24.2%). The EMBOGUARD™ group demonstrated comparable rates of FPE (33.3% vs. 37.2%,
p
= 0.68) and successful recanalization (86.7% vs. 86.0%,
p
= 0.92). Procedural time was significantly shorter in the EMBOGUARD™ group (median 32 min vs. 49 min,
p
= 0.004). Distal embolization rates were similar between groups (4.4% vs. 4.7%,
p
= 1.00). The EMBOGUARD™ group showed significantly higher rates of favorable functional outcome at 90 days (48.6% vs. 28.1%,
p
= 0.04) and non-significantly lower 90-day mortality (13.7% vs. 16.7%,
p
= 0.6). Although favorably trending, multivariate logistic regression analysis did not confirm that EMBOGUARD™ was associated with greater odds of FPE (adjusted odds ratio [aOR] 2.01, 95% confidence interval [CI] 0.65–6.41,
p
= 0.2), mRS 0–2 at 90 days (aOR 1.36, 95% CI 0.35–5.34,
p
= 0.7) or lower odds of mortality at 90 days (aOR 0.32, 95% CI 0.05–1.85,
p
= 0.2).
The EMBOGUARD™ balloon guide catheter demonstrated comparable technical efficacy with reduced procedural times and improved clinical outcomes compared with non-BGC techniques in endovascular thrombectomy for acute ischemic stroke. These findings support the use of EMBOGUARD™ as a reasonable tool for flow arrest in stroke intervention.
R. Morsi, S. Falk, Elena Badillo Goicoechea et al.· Frontiers in Neurology· 0 citations
The DynamX bioadaptor is a novel coronary implant with three helical strands that unlock and separate to provide dynamic vessel support restoring natural vessel function. Evidence in complex bifurcation lesions requiring planned two-stent strategies is limited. This analysis evaluated the feasibility and short-term outcomes of culotte bioadaptor implantation using intravascular ultrasound (IVUS). Thirteen consecutive patients underwent bifurcation percutaneous coronary intervention using culotte technique with DynamX bioadaptor between February and October 2025. All procedures followed a standardized culotte protocol with lesion preparation, proximal optimization technique, rewiring, and final kissing balloon inflation, with IVUS used to assess bioadaptor expansion, apposition, and structural integrity. Technical and procedural success was achieved in all patients (100%), with successful rewiring through bioadaptor struts in all attempts (26 of 26, 100%). IVUS demonstrated satisfactory expansion: main branch ostial expansion 94.9% ± 10.6%, side branch ostial expansion 90.2% ± 17.5%, and proximal expansion ratio 0.95 ± 0.16. No strut fractures or malapposition occurred. Early experience with bioadaptor implantation in culotte bifurcation stenting demonstrates feasibility, with favorable acute IVUS findings in selected patients.
Van Hoang, Giang Tra Tran, Dung Tran Ngoc et al.· Journal of Cardiovascular Im...· 0 citations
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