Stent Retriever as Distal Filter for Endovascular Management of Acute Atherosclerosis-Related Carotid Occlusions: Preliminary Findings with a Novel Technique

<b>Objectives:</b> This study focuses on a novel endovascular technique for treating acute ischemic stroke caused by carotid artery occlusion (CAO) related to extracranial atherosclerosis, a condition typically associated with poor outcomes due to extensive brain infarction and high hemorrhagic risk. While stent retriever thrombectomy is effective for large-vessel occlusions, managing atherosclerosis-related CAO presents challenges. <b>Methods:</b> This retrospective analysis involved a cohort of 18 consecutive patients treated at our center using a new approach that employs a balloon guide catheter (BGC) to access the common carotid artery. Stent retrievers are used as distal filters, and angioplasty is performed through the stent pusher. The technique aims to reduce procedural time and prevent distal embolisms, which are common complications in traditional methods. <b>Results:</b> The results indicate that this approach improves intervention times, increases first-pass success rates, and decreases distal embolism occurrences compared to conventional techniques. It also effectively overcomes obstacles like the management of antiplatelet therapy and lengthy procedures. <b>Conclusions</b>: These preliminary findings demonstrate that using stent retrievers as filters with BGCs, without the need for aspiration catheters, may offer a safer and faster treatment option for atherosclerosis-related CAO. However, further research is required to confirm these findings and potentially establish this technique as the standard in clinical practice.