BOBBY balloon guide catheter thrombectomy in large-vessel occlusion stroke: Initial experience

Abstract

Background and Purpose Nonrandomized studies have found Balloon Guide Catheter (BGC) use to improve technical and functional outcomes in patients undergoing mechanical thrombectomy (MT). Materials and Methods We performed a retrospective analysis on prospectively collected data of consecutive ischemic stroke patients undergoing MT at our institution (December 2020-October 2021). Interventions where BOBBY BGC (BBGC, MicroVentionTM, Aliso Viejo, CA) was used were identified. Baseline demographics and clinico-radiographic characteristics were retrospectively collected and analysed using descriptive statistics. Results A total of 43 patients received BBGC-MT (male: female = 26:17, median age 72 years [IQR 62-82]). The most common occlusion site was the middle cerebral artery (MCA) (60.4%). Over half (51.2%) received intravenous thrombolytics. The BBGC tracked well over tortuous aortic arches (type II 34.8%, type III 16.3%), with median arteriotomy-to-perfusion time of 29 min (IQR 20-46). Thromboaspiration was used as first-line MT technique in 69.7% cases, with 1 (IQR 1-2) median MT pass achieving modified TICI (thrombolysis in cerebral ischemia) scores of 3 and 2b/3 in 74.4% and 95.3% respectively. Our overall first pass effect (FPE, defined as mTICI 3 after firs-pass) and modified FPE (defined as, mTICI 2b/3 after first-pass) rates were 51.1% and 79.1% respectively, with rates of 92.3% and 100% respectively when stentretriever and thromboaspiration were combined. The median reduction in National Institutes of Health Stroke Scale (NIHSS) was 9 (IQR 4–15, p < 0.0001), with a median 90-day modified Rankin Score (mRS) of 1.5 (IQR 0-2). Conclusions BOBBY BGC use resulted in a high first-pass effect rate and may contribute towards improved functional outcomes.

Predictors of Angiographic Outcome After Failed Thrombectomy for Large Vessel Occlusion: Insights from the Stroke Thrombectomy and Aneurysm Registry

“…Although several studies suggest a potential benefit with the use of BGC during MT, we found no association between use of a BGC and MTS or MTF. [34][35][36] Limitations Our study has several limitations. The data are retrospectively analyzed and nonrandomized.…”

“…Although several studies suggest a potential benefit with the use of BGC during MT, we found no association between use of a BGC and MTS or MTF. 34-36…”

Effect of proximal blood flow arrest during endovascular thrombectomy (ProFATE): Study protocol for a multicentre randomised controlled trial

“…BOBBY; Microvention, USA, Walrus; Q'Apel Medical, USA, EMBOGUARD; Cerenovus, USA), which are able to accommodate large bore distal aspiration catheters (e.g. Sofia 6 Plus), similar to those currently used alongside conventional (non-balloon) guide catheters (27,28). However, only the 8Fr Flowgate 2 (Stryker, USA) BGC, which has a smaller internal diameter of 0.084 inches, and the 8Fr Cello BGC (Medtronic, USA) are available for commercial use in the United Kingdom at present, thereby limiting the compatibility with large bore aspiration catheters, which have been associated with improved procedural and clinical outcomes (29).…”

“…Sofia 6 Plus), similar to those currently used alongside conventional (non-balloon) guide catheters. 27,28 However, only the 8 Fr Flowgate 2 (Stryker, USA) BGC, which has a smaller internal diameter of 0.084″, and the 8 Fr Cello BGC (Medtronic, USA) are available for commercial use in the United Kingdom at present, thereby limiting the compatibility with large bore aspiration catheters, which have been associated with improved procedural and clinical outcomes. 29 Nevertheless, this trial sought to investigate the concept of proximal flow arrest during EVT as opposed to the efficacy of specific BGCs themselves.…”