The ANTRACK Technique: Employing a Compliant Balloon or Stent Retriever to Advance a Large-Bore Catheter to an Occlusion During Thrombectomy Procedures in Acute Stroke Patients

BACKGROUND: Stent retrievers and thrombosuction catheters have become the cornerstones of acute stroke therapy. A large-lumen catheter facilitates the passage of different instruments and the application of greater suction force to clots. However, positioning a flexible thrombosuction or intermediate catheter within a tortuous artery is difficult and time-consuming. OBJECTIVE: To evaluate the efficacy and safety of the ANchor TRACKing (ANTRACK) technique in achieving distal positioning of a large-lumen catheter in a tortuous cranial artery. We summarize our experience using either a compliant balloon catheter or a stent retriever as an anchor in the distal vessels to facilitate the navigation of a large-lumen catheter into the distal circulation. METHODS: Consecutive patients who underwent thrombectomy using the ANTRACK technique were identified. Patient characteristics, procedure details, and outcomes were reviewed from our database. The efficacy and safety of advancing thrombosuction or intermediate catheters to the site of an occlusion were the primary outcome measures. Secondary outcomes included the recanalization result. RESULTS: Thirty-nine patients who underwent thrombectomy using the ANTRACK technique were identified; a compliant balloon was used in 32 patients and a stent-retriever was used in 7 patients. The primary outcomes were achieved in all patients. No adverse event was observed. The secondary outcome of recanalization of an occluded artery was achieved in 34 patients (87.2%). CONCLUSION: The ANTRACK technique using either a compliant balloon catheter or a stent-retriever is an effective and safe way of passing a large-bore catheter through a tortuous carotid siphon, particularly in cases with atheromatous plaque or ulceration.