Abstract 388: Real World Experience Using the Balt Carrier Delivery Catheter for Intracranial Access During Mechanical Thrombectomy

Introduction Delivery catheters that reduce the ledge effect of aspiration catheters while maintaining a tapered atraumatic tip have recently become a focus for intracranial access during treatment of acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT). Most companies package their proprietary insert catheter with their own aspiration catheter. The Balt Carrier (The Balt Group, Montmorency, France) is the only separately packaged delivery catheter which comes in three sizes and is designed to safely and efficiently deliver the operator's aspiration catheter of choice to the face of the thrombus with or without the use of a wire. In this study, we share our experience using the Balt Carrier delivery catheter for patients undergoing MT for AIS. Methods We conducted a retrospective case series study of prospectively collected AIS patients undergoing MT at two comprehensive stroke centers. Patients were included in the study if Carrier was utilized to advance an aspiration catheter to the face of an intracranial thrombus. First pass was defined as the time at which the aspiration catheter engaged the clot. We defined successful recanalization as a reperfusion score of TICI 2b or greater. Carrier complications were defined as any vessel injury detected on angiogram during intervention or symptomatic hemorrhage detected on head CT with a change in NIHSS greater than 3 points. Results In nineteen patients, 4 ICA, 12 M1, 2 M2, and 1 basilar artery occlusion were targeted for MT. Four different 6F aspiration catheters were utilized ranging in ID from 0.070” to 0.071.” All three sizes of Carrier were utilized: 4 small, 13 medium, 2 large. The aspiration catheter successfully reached the target lesion in all cases (19/19) on first attempt. A wire was used in nine cases. Of those nine cases, 6 were physician preference and 3 required a wire because the Carrier tip atraumatically entered two fetal Pcomms and one posterior meningeal artery. The median puncture time to first pass and puncture time to successful reperfusion was 16 minutes and 25 minutes respectively. There were no complications. Conclusion The Balt Carrier delivery catheter was successful in delivering various aspiration catheters for intracranial access to the target occlusion with no complications. Reducing the ledge effect of various aspiration catheters during MT while maintaining an atraumatic tip may help safely expedite intracranial access with even larger catheters. More studies are needed to confirm the results of this small two center retrospective study.