Abstract 216: Carrier‐plasty: A Modified Dotter Technique Using the Tapered Balt Carrier Catheter

• Published in: Stroke: vascular and interventional neurology 2024-11, Vol.4 (S1)
• Main Authors: Haimi, J, Snyder, T, Scarpeillo, S, Zacharatos, H, Jankowitz, B
• Format: Article
• Language: English
• Subjects: Angioplasty; Catheters
• ISSN: 2694-5746; 2694-5746
• DOI: 10.1161/SVIN.04.suppl_1.216

IntroductionDespite maximal medical therapy, a subset of patients experience recurrent stroke, particularly those with evidence of hemodynamic insufficiency due to ICAD. Endovascular treatment may play a role in these cases. The advent of tapered, hydrophilic coated insert catheters, such as Balt Carrier, creates an alternative means of angioplasty which may safely treat intracranial stenosis.MethodsWe present a 55‐year‐old female with recurrent right ACA distribution strokes while on best medical therapy treated with a modified Dotter technique. The right proximal anterior cerebral artery (ACA) harbored a 99% stenosis. The A1 measured 1.7mm. The right posterior cerebral artery (PCA) harbored a 80% stenosis and there was no cross filling through the A.comm.ResultsUnder conscious sedation, a 6F benchmark was advanced radially into the petrous segment of the right ICA. A Zoom 14 wire was advanced past the right‐A1 stenosis and into the A3 segment. A Small Balt Carrier Delivery Catheter (OD 1.5 mm) was then advanced distal to the stenosis over the wire to successfully angioplasty the stenotic A1 segment. The Carrier was left in place for 10 seconds. Subsequent AP and lateral runs demonstrated a reduction from 99% to 55% stenosis (using the WASID criteria) (Fig. 1) with improved transit time from 6 seconds to 2.5 seconds (measured from first signs of contrast opacification of the A1 to first appearance of the regional cortical vein). Radial puncture to application of TR band lasted 20 minutes. The patient tolerated the procedure well without complication.Figure 1: DSA demonstrating 99% right‐A1 stenosis, pre‐angioplasty (left), advancement of a wire to the A3 segment. Proximal marker of the Carrier catheter indicates the transition from the catheter's narrow taper to the maximal outer diameter [Arrow] (middle), improvement to 55% stenosis, post‐angioplasty (right)Conclusions:The Balt Carrier catheter was designed to deliver devices endovascularly. However, its trackability, hydrophilic coating, and tapered, atraumatic tip optimize its use in a modified Dotter technique. This may represent the first reported case of the Carrier catheter to treat ICAD with immediate angiographic improvement.