Case Report: Balloon-assisted catheter advancement for antegrade recanalization of non-acute carotid artery occlusions
Background Endovascular recanalization of non-acute internal carotid artery occlusion (NA-ICAO) remains technically challenging. This technical report describes the Balloon-Assisted Catheter Advancement (BACAT) technique and evaluates its procedural feasibility in a small, heterogenous patient cohort. Methods We retrospectively reviewed 15 patients with NA-ICAO who underwent BACAT-assisted recanalization. Cases included both pure endovascular therapy (n = 8) and hybrid therapy combined open surgery with endovascualr therapy (n = 7). The primary outcome was technical success, defined as successful antegrade passage of the catheter across the occlusive segment using the BACAT maneuver. Procedural complications were recorded descriptively. Results Technical success was achieved in 13 of 15 patients (86.7%). No intraprocedural rupture or flow-limiting dissection occurred. One non-disabling postoperative stroke (6.7%) was observed in the hybrid subgroup. Given the small sample, absence of a control group, and case heterogeneity, no statistical comparisons or efficacy claims are made. Conclusions The BACAT technique appears technically feasible for selected patients with NA-ICAO, including both pure endovascular therapy and hybrid surgical. This report provides procedural details to facilitate replication and further investigation. Clinical efficacy and comparative safety require validation in larger, controlled studies.