Comparing the Conventional and Balloon-Guided Catheter-Assisted SWIM Technology for the Treatment of Acute Ischemic Stroke

Abstract

ObjectiveAcute ischemic stroke is common in elder patients. This study investigates whether using the balloon-guided catheter (BGC) would improve the effect of stent thrombectomy (Solitaire FR With Intracranial Support Catheter for Mechanical Thrombectomy, SWIM) for patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO).MethodThe data of 209 patients with AIS-LVO underwent SWIM were collected retrospectively from January 2017 to June 2021. These patients were divided into two groups based on whether they used of BGC or not. The propensity score matching (PSM) analysis was used to compare the differences in the first pass effect (FPE), successful recanalization, embolus escape rate, symptomatic intracranial hemorrhage (sICH), 90-day clinical favorable outcome, 90-day all-cause mortality, and complications in the patients treated with SWIM combined with balloon-guided catheter or conventional catheter.ResultsAmong the 209 patients, 44 patients were treated with BGC and 165 patients were not. After matching, a total of 111 patients were included. The results showed that there was no statistical difference in FPE (35.1% in non-BGC group compared to 24.3% in BGC group, matched RR, 0.59; 95% CI, 0.24–1.44), successful recanalization (89.2 vs. 91.9%, matched RR, 1.37; 95%CI, 0.34–5.51), embolus escape (6.8 vs. 8.1%, matched RR, 1.22; 95%CI, 0.28–5.40), sICH (8.1 vs. 13.5%; matched RR, 1.77; 95%CI 0.50–6.24), 90-day clinical favorable outcome (48.7 vs. 54.1%, matched RR, 1.11; 95%CI 0.51–2.46), 90-day all-cause mortality (17.6 vs. 21.6%, matched RR, 1.29; 95%CI 0.48–3.47), and the incidence of complications (6.8 vs. 5.4%, matched RR, 0.79 95%CI 0.15–4.27). These results indicate that using SWIM as the first-line treatment for patients with AIS-LVO, there is no statistical significance in FPE, final successful recanalization, distal emboli, sICH, procedural time, 90-day favorable outcome, 90-day mortality, and complications with or without BGC.ConclusionBalloon-guided catheter does not affect the result of using SWIM as the first-line treatment for patients with AIS-LVO. Our results will guide daily practice, with the adoption of the use of a guided catheter without a balloon.

Comparison of Clinical and Radiological Outcomes Between Different (Balloon) Guide Catheter With and Without Inflated Balloon in Acute Ischemic Stroke Patients: A MaSQ-Registry Study

“…The overall procedural complication rate was lower when using a non-BGC compared to a BGC with inflated balloon (aOR: 0.41, 95%CI 0.20-0.86). This result is in contrast to the literature, as previous studies have reported lower or comparable rates of complications when using a BGC with inflated balloon compared to a non-BGC [19,20]. This difference in complication rate may be partly explained by the way complications were registered in the current study.…”

“…Regarding the first-line thrombectomy technique, a meta-analysis showed improved clinical and procedural outcomes when using a BGC compared to a non-BGC when stent retriever only or direct aspiration only was used as first-line technique, but not when a combined technique was used as first-line technique [21]. This is in line with some literature showing no effect of using a BGC versus a non-BGC when the combined technique was used [12,20]. In subgroup analyses, we observed comparable results between the BGC groups when the combined technique was used as first-line technique.…”

Balloon guide catheter effect on first pass and revascularization success

“…Arguments against BGCs include their varying compatibility with certain MT devices, reported vascular complications 16 , and the opinion that the catheters used in MT procedures are enough to partially occlude antegrade flow and adequately reduce the risk of distal emboli [14][15] . In addition, a few studies have contradicted previous findings of BGC EVT superiority and demonstrated no significant difference in clinical or reperfusion outcomes between BGC and non-BGC EVT [18][19] , though these studies compared BGC SR-MT with combination SR-CAT. Notably, the most recent and largest study to demonstrate non-superiority of BGCs is the 2022 analysis of the ASSIST registry which assessed the outcomes of 1,300 thrombectomies and found no difference in FP or final RV scores between BGC EVT and non-BGC EVT groups 21 .…”