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Research ArticleNeurointervention

The Dilator-Dotter Technique: A Modified Method of Rapid Internal Carotid Artery Revascularization in Acute Ischemic Stroke

K. Amuluru, D. Sahlein, F. Al-Mufti, T. Payner, C. Kulwin, A. DeNardo and J. Scott
American Journal of Neuroradiology October 2020, 41 (10) 1863-1868; DOI: https://doi.org/10.3174/ajnr.A6733
K. Amuluru
aFrom the Division of Neurointerventional Radiology (K.A., D.S., A.D., J.S.)
dDivision of Neurointerventional Radiology (K.A., D.S., A.D., J.S.)
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D. Sahlein
aFrom the Division of Neurointerventional Radiology (K.A., D.S., A.D., J.S.)
dDivision of Neurointerventional Radiology (K.A., D.S., A.D., J.S.)
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F. Al-Mufti
cDepartment of Neuroendovascular Surgery and Neurocritical Care (F.A.-M.), Westchester Medical Center at New York Medical College, Valhalla, New York
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T. Payner
bDivision of Cerebrovascular Neurosurgery (T.P., C.K.), Goodman Campbell Brain and Spine, Indianapolis, Indiana
eDivision of Cerebrovascular Neurosurgery (T.P., C.K.), Ascension St. Vincent's Medical Center, Indianapolis, Indiana
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C. Kulwin
bDivision of Cerebrovascular Neurosurgery (T.P., C.K.), Goodman Campbell Brain and Spine, Indianapolis, Indiana
eDivision of Cerebrovascular Neurosurgery (T.P., C.K.), Ascension St. Vincent's Medical Center, Indianapolis, Indiana
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A. DeNardo
aFrom the Division of Neurointerventional Radiology (K.A., D.S., A.D., J.S.)
dDivision of Neurointerventional Radiology (K.A., D.S., A.D., J.S.)
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J. Scott
aFrom the Division of Neurointerventional Radiology (K.A., D.S., A.D., J.S.)
dDivision of Neurointerventional Radiology (K.A., D.S., A.D., J.S.)
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Abstract

BACKGROUND AND PURPOSE: Acute ischemic stroke due to tandem occlusive lesions involves high-grade ICA stenosis or occlusion with a distal intracranial occlusion. Several approaches and devices exist in the treatment of tandem occlusions; however, a consensus on the optimal technique does not exist. The Dotter technique is a method of catheter-based angioplasty to recanalize cervical ICA occlusions. We present a modified dilator-Dotter technique, which involves a polyethylene, tapered inner dilator to initially cross the occlusion, followed by guide catheterization and subsequent intracranial thrombectomy. The purpose of this study was to examine the safety and efficacy of this dilator-Dotter technique.

MATERIALS AND METHODS: We performed a retrospective review of patients with acute stroke due to tandem ICA intracranial occlusions, treated with our dilator-Dotter technique and thrombectomy between June 2018 and December 2019. We examined clinical, radiographic, and procedural data, as well as complications and outcomes.

RESULTS: Thirty-two patients were included. In 100% of cases, the dilator-Dotter technique resulted in ICA recanalization allowing successful thrombectomy. TICI 2b-3 revascularization was obtained in 31 patients (96%), within an average time of 25 minutes. The average preprocedural ICA stenosis was 98%, including 23 patients (72%) with complete occlusion. Following the dilator-Dotter technique, average ICA stenosis improved to 59%. There were no instances of death, iatrogenic dissection, emboli to new territory, or symptomatic intracranial hemorrhage.

CONCLUSIONS: The dilator-Dotter technique may be a safe and effective modification of the traditional Dotter technique in allowing rapid ICA recanalization in cases of acute ischemic stroke due to tandem occlusions.

ABBREVIATIONS:

ADAPT
direct aspiration first-pass technique
AIS
acute ischemic stroke
ICH
intracranial hemorrhage
LVO
large-vessel occlusion
sICH
symptomatic intracranial hemorrhage
  • © 2020 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 41 (10)
American Journal of Neuroradiology
Vol. 41, Issue 10
1 Oct 2020
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Cite this article
K. Amuluru, D. Sahlein, F. Al-Mufti, T. Payner, C. Kulwin, A. DeNardo, J. Scott
The Dilator-Dotter Technique: A Modified Method of Rapid Internal Carotid Artery Revascularization in Acute Ischemic Stroke
American Journal of Neuroradiology Oct 2020, 41 (10) 1863-1868; DOI: 10.3174/ajnr.A6733

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The Dilator-Dotter Technique: A Modified Method of Rapid Internal Carotid Artery Revascularization in Acute Ischemic Stroke
K. Amuluru, D. Sahlein, F. Al-Mufti, T. Payner, C. Kulwin, A. DeNardo, J. Scott
American Journal of Neuroradiology Oct 2020, 41 (10) 1863-1868; DOI: 10.3174/ajnr.A6733
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