Efficacy of Balloon-Guiding Catheter for Mechanical Thrombectomy in Patients with Anterior Circulation Ischemic Stroke

Abstract

ObjectiveTo evaluate the efficacy of balloon guiding catheter (BGC) during thrombectomy in anterior circulation ischemic stroke.MethodsSixty-two patients with acute anterior circulation ischemic stroke were treated with thrombectomy using a Solitaire stent from 2011 to 2016. Patients were divided into the BGC group (n=24, 39%) and the non-BGC group (n=38, 61%). The number of retrievals, procedure time, thrombolysis in cerebral infarction (TICI) grade, presence of distal emboli, and clinical outcomes at 3 months were evaluated.ResultsSuccessful recanalization was more frequent in BGC than in non-BGC (83% vs. 66%, p=0.13). Distal emboli occurred less in BGC than in non-BGC (23.1% vs. 57.1%, p=0.02). Good clinical outcome was more frequent in BGC than in non-BGC (50% vs. 16%, p=0.03). The multivariate analysis showed that use of BGC was the only independent predictor of good clinical outcome (odds ratio, 5.19: 95% confidence interval, 1.07–25.11). More patients in BGC were successfully recanalized in internal carotid artery (ICA) occlusion with small retrieval numbers (<3) than those in non-BGC (70% vs. 24%, p=0.005). In successfully recanalized ICA occlusion, distal emboli did not occur in BGC, whereas nine patients had distal emboli in non-BGC (0% vs. 75%, p=0.001) and good clinical outcome was superior in BGC than in non-BGC (55.6% vs. 8.3%, p=0.01).ConclusionA BGC significantly reduces the number of retrievals and the occurrence of distal emboli, thereby resulting in better clinical outcomes in patients with anterior circulation ischemic stroke, particularly with ICA occlusion.

Effectiveness and Safety of Mechanical Thrombectomy with Stent Retrievers in Basilar Artery Occlusion : Comparison with Anterior Circulation Occlusions

“…When comparing complications, distal embolization frequency was higher with BAO, but symptomatic hemorrhage occurred less in BAO than ACO. This increased incidence of distal embolization with BAO may be associated with a low application rate of BGC for BAO compared with ACO 17) . The use of BGC was limited due to the narrow diameter and tortuosity of the vertebra-basilar artery (17.5%), compared with anterior circulation (51.8%), therefore, distal embolization increased during mechanical thrombectomy of BAO than ACO.…”

Role of Balloon Guide Catheter in Modern Endovascular Thrombectomy

“…A Direct Aspiration J Korean Neurosurg Soc 63 (1) : [14][15][16][17][18][19][20][21][22][23][24][25] First Pass Technique (ADAPT) or contact aspiration thrombectomy (CAT) using large bore catheters is also employed as another frontline treatment for LVO 12,24,32) . During the evolution of thrombectomy strategies, the versatile uses of 8 F or 9 F balloon guide catheters (BGC) in different clinical setups have been recognized as BGCs can be paired with a single clot retriever system 23,48) or combined with other adjunctive thrombectomy procedures 15,37,39) .…”

“…[47][48][49][50][51][52][53] 2005 32. Lapergue B, Blanc R, Gory B, Labreuche J, Duhamel A, Marnat G, et al : Effect of endovascular contact aspiration vs stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion: the ASTER randomized clinical trial.…”

Comparison of FlowGate2 and Merci as balloon guide catheters used in mechanical thrombectomies for stroke intervention

“…Certain studies have reported advantages of BGCs, such as prevention of thromboembolic complications, increased suction effectiveness, facilitation of clot removal, minimization of distal embolization and a shorter procedure time (7,(9)(10)(11). MT using BGCs has been indicated to facilitate improved clinical and radiological outcomes, compared with other techniques, via a reduction in both the number of stent passages' and incidence of distal emboli (10,12,13).…”