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<meta name="DC.Title" content="GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery (GUARD) Technique during Thrombectomy Improves Reperfusion and Clinical Outcomes" />
<meta name="DC.Identifier" content="10.3174/ajnr.A6132" />
<meta name="DC.Date" content="2019-08-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2019 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Adjunctive techniques to stent retriever thrombectomy include balloon-guide catheters and/or distal access catheters for aspiration. We describe a novel technique using a flexible, 6 French 088 distal guide sheath advanced past the skull base to augment mechanical thrombectomy. We studied the relative safety and efficacy of this technique in the setting of a combined stent retriever–distal access catheter aspiration thrombectomy protocol.

MATERIALS AND METHODS: We performed a retrospective case-control study of intracranial internal carotid artery or M1–M2 middle cerebral artery occlusions requiring mechanical thrombectomy. Patients were divided into 2 groups based on thrombectomy techniques: conventional stent retriever with distal access catheter aspiration without (standard) and with adjunctive GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery (GUARD). Using propensity score matching, we compared procedural safety, reperfusion efficacy using the modified Thrombolysis in Cerebral Infarction scale and clinical outcomes with the modified Rankin Scale.

RESULTS: In comparing the GUARD (45 patients) versus standard (45 matched case controls) groups, there were no significant differences in demographics, NIHSS presentations, IV rtPA use, median onset-to-groin puncture times, procedural complications, symptomatic intracranial hemorrhage, or mortality. The GUARD group demonstrated significantly higher successful mTICI ≥2b reperfusion rates (98% versus 80%, P = .015) and improved functional mRS ≤2 outcomes (67% versus 43%, P = .04), with independent effects of the GUARD technique confirmed in a multivariable logistic regression model.

CONCLUSIONS: The GUARD technique during mechanical thrombectomy with combined stent retrieval–distal access catheter aspiration is safe and effective in improving reperfusion and clinical outcomes.

BGC
:   balloon-guide catheter
DAC
:   distal access catheter
DGS
:   distal guide sheath
GUARD
:   GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery
F
:   French
mTICI
:   modified Thrombolysis in Cerebral Infarction
mRS
:   modified Rankin Scale
NIHSS
:   National Institutes of Health Stroke Scale
ASPECTS
:   Alberta Stroke Program Early CT Score
ICA
:   internal carotid artery
MCA
:   middle cerebral artery
IV rtPA
:   intravenous recombinant tissue plasminogen activator
SICH
:   symptomatic intracranial hemorrhage
ELVO
:   emergent large-vessel occlusions" />
<meta name="DC.Contributor" content="S.A. Ansari" />
<meta name="DC.Contributor" content="M. Darwish" />
<meta name="DC.Contributor" content="R.N. Abdalla" />
<meta name="DC.Contributor" content="D.R. Cantrell" />
<meta name="DC.Contributor" content="A. Shaibani" />
<meta name="DC.Contributor" content="M.C. Hurley" />
<meta name="DC.Contributor" content="B.S. Jahromi" />
<meta name="DC.Contributor" content="M.B. Potts" />
<meta name="article:published_time" content="2019-08-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery (GUARD) Technique during Thrombectomy Improves Reperfusion and Clinical Outcomes" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Adjunctive techniques to stent retriever thrombectomy include balloon-guide catheters and/or distal access catheters for aspiration. We describe a novel technique using a flexible, 6 French 088 distal guide sheath advanced past the skull base to augment mechanical thrombectomy. We studied the relative safety and efficacy of this technique in the setting of a combined stent retriever–distal access catheter aspiration thrombectomy protocol.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We performed a retrospective case-control study of intracranial internal carotid artery or M1–M2 middle cerebral artery occlusions requiring mechanical thrombectomy. Patients were divided into 2 groups based on thrombectomy techniques: conventional stent retriever with distal access catheter aspiration without (standard) and with adjunctive GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery (GUARD). Using propensity score matching, we compared procedural safety, reperfusion efficacy using the modified Thrombolysis in Cerebral Infarction scale and clinical outcomes with the modified Rankin Scale.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;In comparing the GUARD (45 patients) versus standard (45 matched case controls) groups, there were no significant differences in demographics, NIHSS presentations, IV rtPA use, median onset-to-groin puncture times, procedural complications, symptomatic intracranial hemorrhage, or mortality. The GUARD group demonstrated significantly higher successful mTICI ≥2b reperfusion rates (98% versus 80%, &lt;i&gt;P&lt;/i&gt; = .015) and improved functional mRS ≤2 outcomes (67% versus 43%, &lt;i&gt;P&lt;/i&gt; = .04), with independent effects of the GUARD technique confirmed in a multivariable logistic regression model.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;The GUARD technique during mechanical thrombectomy with combined stent retrieval–distal access catheter aspiration is safe and effective in improving reperfusion and clinical outcomes.&lt;/p&gt;" />
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<meta name="citation_author_institution" content="cNeurological Surgery (S.A.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois" />
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<meta name="twitter:title" content="GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery (GUARD) Technique during Thrombectomy Improves Reperfusion and Clinical Outcomes" />
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<meta name="twitter:image" content="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/40/8.cover-source.jpg" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Adjunctive techniques to stent retriever thrombectomy include balloon-guide catheters and/or distal access catheters for aspiration. We describe a novel technique using a flexible, 6 French 088 distal guide sheath advanced past the skull base to augment mechanical thrombectomy. We studied the relative safety and efficacy of this technique in the setting of a combined stent retriever–distal access catheter aspiration thrombectomy protocol.

MATERIALS AND METHODS: We performed a retrospective case-control study of intracranial internal carotid artery or M1–M2 middle cerebral artery occlusions requiring mechanical thrombectomy. Patients were divided into 2 groups based on thrombectomy techniques: conventional stent retriever with distal access catheter aspiration without (standard) and with adjunctive GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery (GUARD). Using propensity score matching, we compared procedural safety, reperfusion efficacy using the modified Thrombolysis in Cerebral Infarction scale and clinical outcomes with the modified Rankin Scale.

RESULTS: In comparing the GUARD (45 patients) versus standard (45 matched case controls) groups, there were no significant differences in demographics, NIHSS presentations, IV rtPA use, median onset-to-groin puncture times, procedural complications, symptomatic intracranial hemorrhage, or mortality. The GUARD group demonstrated significantly higher successful mTICI ≥2b reperfusion rates (98% versus 80%, P = .015) and improved functional mRS ≤2 outcomes (67% versus 43%, P = .04), with independent effects of the GUARD technique confirmed in a multivariable logistic regression model.

CONCLUSIONS: The GUARD technique during mechanical thrombectomy with combined stent retrieval–distal access catheter aspiration is safe and effective in improving reperfusion and clinical outcomes.

BGC
:   balloon-guide catheter
DAC
:   distal access catheter
DGS
:   distal guide sheath
GUARD
:   GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery
F
:   French
mTICI
:   modified Thrombolysis in Cerebral Infarction
mRS
:   modified Rankin Scale
NIHSS
:   National Institutes of Health Stroke Scale
ASPECTS
:   Alberta Stroke Program Early CT Score
ICA
:   internal carotid artery
MCA
:   middle cerebral artery
IV rtPA
:   intravenous recombinant tissue plasminogen activator
SICH
:   symptomatic intracranial hemorrhage
ELVO
:   emergent large-vessel occlusions" />
<meta name="og-title" property="og:title" content="GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery (GUARD) Technique during Thrombectomy Improves Reperfusion and Clinical Outcomes" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/40/8/1356" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Adjunctive techniques to stent retriever thrombectomy include balloon-guide catheters and/or distal access catheters for aspiration. We describe a novel technique using a flexible, 6 French 088 distal guide sheath advanced past the skull base to augment mechanical thrombectomy. We studied the relative safety and efficacy of this technique in the setting of a combined stent retriever–distal access catheter aspiration thrombectomy protocol.

MATERIALS AND METHODS: We performed a retrospective case-control study of intracranial internal carotid artery or M1–M2 middle cerebral artery occlusions requiring mechanical thrombectomy. Patients were divided into 2 groups based on thrombectomy techniques: conventional stent retriever with distal access catheter aspiration without (standard) and with adjunctive GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery (GUARD). Using propensity score matching, we compared procedural safety, reperfusion efficacy using the modified Thrombolysis in Cerebral Infarction scale and clinical outcomes with the modified Rankin Scale.

RESULTS: In comparing the GUARD (45 patients) versus standard (45 matched case controls) groups, there were no significant differences in demographics, NIHSS presentations, IV rtPA use, median onset-to-groin puncture times, procedural complications, symptomatic intracranial hemorrhage, or mortality. The GUARD group demonstrated significantly higher successful mTICI ≥2b reperfusion rates (98% versus 80%, P = .015) and improved functional mRS ≤2 outcomes (67% versus 43%, P = .04), with independent effects of the GUARD technique confirmed in a multivariable logistic regression model.

CONCLUSIONS: The GUARD technique during mechanical thrombectomy with combined stent retrieval–distal access catheter aspiration is safe and effective in improving reperfusion and clinical outcomes.

BGC
:   balloon-guide catheter
DAC
:   distal access catheter
DGS
:   distal guide sheath
GUARD
:   GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery
F
:   French
mTICI
:   modified Thrombolysis in Cerebral Infarction
mRS
:   modified Rankin Scale
NIHSS
:   National Institutes of Health Stroke Scale
ASPECTS
:   Alberta Stroke Program Early CT Score
ICA
:   internal carotid artery
MCA
:   middle cerebral artery
IV rtPA
:   intravenous recombinant tissue plasminogen activator
SICH
:   symptomatic intracranial hemorrhage
ELVO
:   emergent large-vessel occlusions" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node69537--5" data-node-nid="69537" id="top-node-69537--62118944366" data-pisa="ajnr;40/8/1356" data-pisa-master="ajnr;ajnr.A6132" data-apath="/ajnr/40/8/1356.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Interventional</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery (GUARD) Technique during Thrombectomy Improves Reperfusion and Clinical Outcomes</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">S.A. Ansari</span>, <span class="highwire-citation-author" data-delta="1">M. Darwish</span>, <span class="highwire-citation-author" data-delta="2">R.N. Abdalla</span>, <span class="highwire-citation-author" data-delta="3">D.R. Cantrell</span>, <span class="highwire-citation-author" data-delta="4">A. Shaibani</span>, <span class="highwire-citation-author" data-delta="5">M.C. Hurley</span>, <span class="highwire-citation-author" data-delta="6">B.S. Jahromi</span> and <span class="highwire-citation-author" data-delta="7">M.B. Potts</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">August 2019,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">40 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1356-1362; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6132 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-69537--62118944366" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">S.A. Ansari </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (S.A.A., M.D., R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.)</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurology (S.A.A.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurological Surgery (S.A.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.A.%2BAnsari%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ansari%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.A.%2BAnsari%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8176-4616" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S.A. Ansari</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">M. Darwish </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (S.A.A., M.D., R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.)</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Neurology (M.D.), Assiut University, Assiut, Egypt</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BDarwish%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Darwish%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BDarwish%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-3393-6898" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Darwish</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">R.N. Abdalla </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (S.A.A., M.D., R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.)</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Radiology (R.N.A.), Ain Shams University, Cairo, Egypt.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.N.%2BAbdalla%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Abdalla%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.N.%2BAbdalla%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-2611-2097" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R.N. Abdalla</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">D.R. Cantrell </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (S.A.A., M.D., R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurological Surgery (S.A.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.R.%2BCantrell%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cantrell%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AD.R.%2BCantrell%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-2444-8948" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D.R. Cantrell</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">A. Shaibani </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (S.A.A., M.D., R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurological Surgery (S.A.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.%2BShaibani%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Shaibani%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.%2BShaibani%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9901-2903" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. Shaibani</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">M.C. Hurley </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (S.A.A., M.D., R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurological Surgery (S.A.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.C.%2BHurley%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hurley%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.C.%2BHurley%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-2873-4738" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.C. Hurley</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">B.S. Jahromi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (S.A.A., M.D., R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurological Surgery (S.A.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=B.S.%2BJahromi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Jahromi%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AB.S.%2BJahromi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-5064-5278" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for B.S. Jahromi</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">M.B. Potts </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (S.A.A., M.D., R.N.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Neurological Surgery (S.A.A., D.R.C., A.S., M.C.H., B.S.J., M.B.P.), Feinberg School of Medicine, Northwestern University, Chicago, Illinois</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.B.%2BPotts%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Potts%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.B.%2BPotts%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-0534-5097" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.B. Potts</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> Adjunctive techniques to stent retriever thrombectomy include balloon-guide catheters and/or distal access catheters for aspiration. We describe a novel technique using a flexible, 6 French 088 distal guide sheath advanced past the skull base to augment mechanical thrombectomy. We studied the relative safety and efficacy of this technique in the setting of a combined stent retriever–distal access catheter aspiration thrombectomy protocol.</p></div><div id="sec-2" class="subsection"><p id="p-2"><strong>MATERIALS AND METHODS:</strong> We performed a retrospective case-control study of intracranial internal carotid artery or M1–M2 middle cerebral artery occlusions requiring mechanical thrombectomy. Patients were divided into 2 groups based on thrombectomy techniques: conventional stent retriever with distal access catheter aspiration without (standard) and with adjunctive GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery (GUARD). Using propensity score matching, we compared procedural safety, reperfusion efficacy using the modified Thrombolysis in Cerebral Infarction scale and clinical outcomes with the modified Rankin Scale.</p></div><div id="sec-3" class="subsection"><p id="p-3"><strong>RESULTS:</strong> In comparing the GUARD (45 patients) versus standard (45 matched case controls) groups, there were no significant differences in demographics, NIHSS presentations, IV rtPA use, median onset-to-groin puncture times, procedural complications, symptomatic intracranial hemorrhage, or mortality. The GUARD group demonstrated significantly higher successful mTICI ≥2b reperfusion rates (98% versus 80%, <em>P</em> = .015) and improved functional mRS ≤2 outcomes (67% versus 43%, <em>P</em> = .04), with independent effects of the GUARD technique confirmed in a multivariable logistic regression model.</p></div><div id="sec-4" class="subsection"><p id="p-4"><strong>CONCLUSIONS:</strong> The GUARD technique during mechanical thrombectomy with combined stent retrieval–distal access catheter aspiration is safe and effective in improving reperfusion and clinical outcomes.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">BGC<span class="def-item-dt-sep"></span></dt><dd>balloon-guide catheter<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">DAC<span class="def-item-dt-sep"></span></dt><dd>distal access catheter<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">DGS<span class="def-item-dt-sep"></span></dt><dd>distal guide sheath<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">GUARD<span class="def-item-dt-sep"></span></dt><dd>GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">F<span class="def-item-dt-sep"></span></dt><dd>French<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">mTICI<span class="def-item-dt-sep"></span></dt><dd>modified Thrombolysis in Cerebral Infarction<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">mRS<span class="def-item-dt-sep"></span></dt><dd>modified Rankin Scale<span class="def-item-dd-sep"></span></dd><dt id="def-item-8">NIHSS<span class="def-item-dt-sep"></span></dt><dd>National Institutes of Health Stroke Scale<span class="def-item-dd-sep"></span></dd><dt id="def-item-9">ASPECTS<span class="def-item-dt-sep"></span></dt><dd>Alberta Stroke Program Early CT Score<span class="def-item-dd-sep"></span></dd><dt id="def-item-10">ICA<span class="def-item-dt-sep"></span></dt><dd>internal carotid artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-11">MCA<span class="def-item-dt-sep"></span></dt><dd>middle cerebral artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-12">IV rtPA<span class="def-item-dt-sep"></span></dt><dd>intravenous recombinant tissue plasminogen activator<span class="def-item-dd-sep"></span></dd><dt id="def-item-13">SICH<span class="def-item-dt-sep"></span></dt><dd>symptomatic intracranial hemorrhage<span class="def-item-dd-sep"></span></dd><dt id="def-item-14">ELVO<span class="def-item-dt-sep"></span></dt><dd>emergent large-vessel occlusions</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2019 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/40/8/1356.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 40</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 8 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Aug 2019 </div></div>
      
      
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      <div class="highwire-cite-title">GUide sheath Advancement and aspiRation in the Distal petrocavernous internal carotid artery (GUARD) Technique during Thrombectomy Improves Reperfusion and Clinical Outcomes</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">S.A.</span> <span class="nlm-surname">Ansari</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Darwish</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">R.N.</span> <span class="nlm-surname">Abdalla</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.R.</span> <span class="nlm-surname">Cantrell</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Shaibani</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">M.C.</span> <span class="nlm-surname">Hurley</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">B.S.</span> <span class="nlm-surname">Jahromi</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">M.B.</span> <span class="nlm-surname">Potts</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2019, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">40 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1356-1362; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6132 </span></div>
  
  
  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">S.A.</span> <span class="nlm-surname">Ansari</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Darwish</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">R.N.</span> <span class="nlm-surname">Abdalla</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.R.</span> <span class="nlm-surname">Cantrell</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Shaibani</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">M.C.</span> <span class="nlm-surname">Hurley</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">B.S.</span> <span class="nlm-surname">Jahromi</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">M.B.</span> <span class="nlm-surname">Potts</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2019, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">40 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(8) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1356-1362; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6132 </span></div>
  
  
  
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