Balloon Guide Catheter Is Beneficial in Endovascular Treatment Regardless of Mechanical Recanalization Modality

Abstract

Background and Purpose— Based on its mechanism, the use of balloon guide catheters (BGCs) may be beneficial during endovascular treatment, regardless of the type of mechanical recanalization modality used—stent retriever thrombectomy or thrombaspiration. We evaluated whether the use of BGCs can be beneficial regardless of the first-line mechanical endovascular modality used. Methods— We retrospectively reviewed consecutive acute stroke patients who underwent stent retriever thrombectomy or thrombaspiration from the prospectively maintained registries of 17 stroke centers nationwide. Patients were assigned to the BGC or non-BGC group based on the use of BGCs during procedures. Endovascular and clinical outcomes were compared between the BGC and non-BGC groups. To adjust the influence of the type of first-line endovascular modality on successful recanalization and favorable outcome, multivariable analyses were also performed. Results— This study included a total of 955 patients. Stent retriever thrombectomy was used as the first-line modality in 526 patients (55.1%) and thrombaspiration in 429 (44.9%). BGC was used in 516 patients (54.0%; 61.2% of stent retriever thrombectomy patients; 45.2% of thrombaspiration patients). The successful recanalization rate was significantly higher in the BGC group compared with the non-BGC group (86.8% versus 74.7%, respectively; P <0.001). Furthermore, the first-pass recanalization rate was more frequent (37.0% versus 14.1%; P <0.001), and the number of device passes was fewer in the BGC group (2.5±1.9 versus 3.3±2.1; P <0.001). The procedural time was also shorter in the BGC group (54.3±27.4 versus 67.6±38.2; P <0.001). The use of BGC was an independent factor for successful recanalization (odds ratio, 2.18; 95% CI, 1.54–3.10; P <0.001) irrespective of the type of first-line endovascular modality used. The use of BGC was also an independent factor for a favorable outcome (odds ratio, 1.40; 95% CI, 1.02–1.92; P =0.038) irrespective of the type of first-line endovascular modality used. Conclusions— Regardless of the first-line mechanical endovascular modality used, the use of BGC in endovascular treatment was beneficial in terms of both recanalization success and functional outcome.

Comparison of Aspiration versus Stent Retriever Thrombectomy as the Preferred Strategy for Patients with Acute Terminal Internal Carotid Artery Occlusion: A Propensity Score Matching Analysis

“…This device was considered an independent predictor of the first-pass effect success rate from a single thrombectomy device as well as a predictor of recanalization success and optimal clinical outcomes. [15][16][17][18][19] Although it has been recommended as a routine adjuvant technique for stent retrieval by several studies, 5,20 considerable controversy exists, notably when the distal access catheter is used in conjunction with the stent retriever, which may facilitate distal aspiration and minimize the impact of the absence of a BGC. 6 BGCs were not available during the study in our center.…”

“…However, the final successful recanalization rates noted both in the AT and SRT groups were not inferior to the results obtained when using a BGC. 15,16 Although results of one study indicated that the use of a BGC was significantly superior to the application of the distal access catheter, the higher baseline ASPECTS demonstrated lessfrequent ICA occlusions in the BGC group that could lead to significant bias of the results. 15 The median PRT in the AT group was significantly lower than that of the SRT group in the overall sample (P ¼ .001) and the PSM sample (P ¼ .001).…”

“….05). The median (interquartile range) preprocedure NIHSS score was 21 (15-23) in the AT group and 19 (16)(17)(18)(19)(20)(21)(22) in the SRT group (P ¼ .160). The median collateral grades assessed by ASITN/SIRs, the median baseline Alberta Stroke Program Early CT Score (ASPECTS), and the proportion of ASPECTS , 6 in the AT and SRT groups were similar for the overall and the PSM samples (P .…”

Unfavorable Vascular Anatomy during Endovascular Treatment of Stroke: Challenges and Bailout Strategies

“…First, due to the small size of the radial artery, 29,31,32 there is typically a limitation to the use of a 6-Fr sheath, which typically prevents the utilization of BGC shown to be more effective in MT than conventional guiding catheters in both stent-retriever (SR) and contact aspiration (CA) treatment modalities. 33 Second, navigating the aortic arch from the right TRA requires different skills than those required when navigating the same vessels from TFA. A significant learning curve is required and a cut-off of 30 to 50 procedures has been proposed for the full optimization of procedural performance.…”

Recent Trend for Endovascular Treatment in Patients with Acute Ischemic Stroke: Balloon Guide Catheter

“…In a recent meta-analysis, patients treated with a balloon guide catheter for mechanical thrombectomy showed higher odds of first-pass recanalization (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.7–2.6) and modified Rankin Scale 0–2 (OR, 1.84; 95% CI, 1.5–2.2) compared to non-balloon guide catheter group [1]. Baek et al [2] investigated the effect of the balloon guide catheter not only in mechanical thrombectomy but also in aspiration thrombectomy. The balloon guide catheter group demonstrated significantly higher successful recanalization rate (87%) and higher first-pass recanalization rate (37%) compared to those of non-balloon guide catheter group (75% and 14%, respectively; P<0.001 each).…”