Balloon-Assisted Tracking Plus Modified Dotter (BAT-mDOT) Technique for Tandem Acute Ischemic Stroke

Introduction: Tandem occlusions (TO) might involve internal carotid artery (ICA) plaque steno-occlusion with an intracranial large vessel occlusion (LVO). In this case series we present a combined endovascular technique of already known balloon-assisted tracking plus modified Dotter (BAT-mDOT) technique. Internal carotid artery aneurysm. Endovascular treatment was performed followed by Dyna CT which revealed subarachnoid hemorrhage in right sylvian fissure. There was no leakage on check angiography. Dyna CT was repeated after 30 minutes which showed no interval increase in the bleed. Patient clinical condition deteriorated few hours later, CT scan showed interval increase in the bleed. Catheter angiography was done which showed an area of dye extravasation. The leakage site was secured with coil embolization.

Discussion: During arterial perforation in endovascular procedure, the heparin effect is reversed with protamine sulfate. Platelet transfusion and blood pressure control are also recommended. We can use intermittent balloon inflation or parent vessel occlusion if bleeding is not controlled spontaneously.

Publication History

Article published online:
09 February 2023