ABGCEPD for acute symptomatic isolated cervical internal carotid artery occlusion to improve reperfusion and reduce distal embolization

The optimal endovascular strategy for acute symptomatic isolated cervical internal carotid artery occlusion (sICAO) management remains unclear because of the anatomical complexity and high risk of distal embolization. This study looks into the safety, effectiveness, and outcomes of a novel Aspiration-Based Dual-Protection Strategy Under Proximal Balloon Occlusion and Distal Embolic Protection Device (ABGCEPD) for sICAO treatment. This retrospective study involved 65 patients with acute moderate-to-severe stroke who underwent endovascular treatment using ABGCEPD at three hospitals in China between January 2016 and December 2023. The primary outcome included successful reperfusion, defined as a modified Thrombolysis in Cerebral Infarction score ≥ 2b. A good outcome at discharge was defined as a modified 3-month Rankin Scale (mRS) score of 0 to 2 at 90 days. Secondary outcomes included mortality, symptomatic intracranial hemorrhage (sICH), and embolization to new territories (ENT). All 65 patients with sICAO were treated using ABGCEPD. The rate of successful reperfusion (modified Thrombolysis in Cerebral Infarction score ≥ T2b) was 92.9%, with a good clinical outcome attained by 60% of patients (90-day mRS 0-2). The incidence of sICH was 10.7%, mortality was 7.1%, and ENT was 7.0%. ABGCEPD is a feasible, safe, and efficient method for acute sICAO management. It may decrease the incidence of distal embolization during endovascular treatment.