Impact of Balloon Guide Catheter Use on Clinical and Angiographic Outcomes in the STRATIS Stroke Thrombectomy Registry

Abstract

Background and Purpose— Mechanical thrombectomy has been shown to improve clinical outcomes in patients with acute ischemic stroke. However, the impact of balloon guide catheter (BGC) use is not well established. Methods— STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) was a prospective, multicenter study of patients with large vessel occlusion treated with the Solitaire stent retriever as first-line therapy. In this study, an independent core laboratory, blinded to the clinical outcomes, reviewed all procedures and angiographic data to classify procedural technique, target clot location, recanalization after each pass, and determine the number of stent retriever passes. The primary clinical end point was functional independence (modified Rankin Scale, 0–2) at 3 months as determined on-site, and the angiographic end point was first-pass effect (FPE) success rate from a single device attempt (modified Thrombolysis in Cerebral Infarction, ≥2c) as determined by a core laboratory. Achieving modified FPE (modified Thrombolysis in Cerebral Infarction, ≥2b) was also assessed. Comparisons of clinical outcomes were made between groups and adjusted for baseline and procedural characteristics. All participating centers received institutional review board approval from their respective institutions. Results— Adjunctive technique groups included BGC (n=445), distal access catheter (n=238), and conventional guide catheter (n=62). The BGC group had a higher rate of FPE following first pass (212/443 [48%]) versus conventional guide catheter (16/62 [26%]; P =0.001) and distal access catheter (83/235 [35%]; P =0.002). Similarly, the BGC group had a higher rate of modified FPE (294/443 [66%]) versus conventional guide catheter (26/62 [42%]; P <0.001) and distal access catheter (129/234 [55%]; P =0.003). The BGC group achieved the highest rate of functional independence (253/415 [61%]) versus conventional guide catheter (23/55 [42%]; P =0.007) and distal access catheter (113/218 [52%]; P =0.027). Final revascularization and mortality rates did not differ across the groups. Conclusions— BGC use was an independent predictor of FPE, modified FPE, and functional independence, suggesting that its routine use may improve the rates of early revascularization success and good clinical outcomes. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT02239640.

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

“…1,12,13 Moreover, the terminal ICA occlusion was considered to occur with lower complete recanalization in the presence of a single thrombectomy device pass that renders it resistant to current techniques. 14 The rates of the first pass to eTICI 2b-3, 2c-3, and 3 were similar in the overall samples (all P . .05), whereas the rate of the eTICI 2c-3 was higher after PSM (P ¼ .044) in the AT group compared with that of the SRT group.…”

“…Nonterminal ICA occlusion was an independent predictor of achieving complete recanalization with a single thrombectomy device pass. 14 An additional reason for observing a lower rate of the eTICI 2c-3 after the application of all the procedures and the first pass to eTICI 2c-3 in the SRT group may be attributed to the absence of the BGC. 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.…”

Successful reperfusion, rather than number of passes, predicts clinical outcome after mechanical thrombectomy

“…Patients undergoing mechanical thrombectomy for acute ischemic stroke secondary to large vessel occlusion who require a fewer number of passes to achieve successful reperfusion have better functional outcomes than patients who undergo a higher number of passes 1 2. First-pass effect has thus been used as a primary radiographic outcome measure in large studies 3–5. It has also been well established that successful reperfusion predicts outcome and is protective against symptomatic intracranial hemorrhage (sICH), which is associated with worse clinical outcomes after thrombectomy 6 7.…”

Evolution of Stroke Thrombectomy Techniques to Optimize First-Pass Complete Reperfusion

“…39 This improves reperfusion times and quality, and, most importantly, patient outcome. [40][41][42][43] After the BGC is placed in the cervical ICA (►Fig. 1), a microcatheter is advanced over a microwire through a large bore distal access catheter (DAC).…”