A propensity score-matched comparative study of balloon guide catheters versus conventional guide catheters for concurrent mechanical thrombectomy with carotid stenting in tandem strokes: comparison of first pass effect, symptomatic intracranial hemorrhage, and 90-day functional outcomes

Abstract

BackgroundExtensive clot burden in tandem strokes accounts for poor mechanical thrombectomy (MT) outcomes. Several studies have shown the benefit of balloon guide catheters (BGCs) in MT and carotid artery stenting.ObjectiveIn view of this potential benefit, to investigate the safety and effectiveness of proximal flow arrest using a BGC during concurrent MT and carotid revascularization for tandem stroke treatment in a comparative, propensity score-matched (PSM) study.MethodsPatients with a tandem stroke identified from our endovascular database were dichotomized into groups treated with BGCs versus conventional guide catheters. One-to-one PSM adjustment for baseline demographics and treatment selection bias using nearest-neighbor matching was performed. Patient demographics, presentation characteristics, and procedural details were recorded. Outcomes assessed were final modified Thrombolysis in Cerebral Infarction (mTICI) grade, periprocedural symptomatic intracranial hemorrhage (sICH) rate, in-hospital mortality, and 90-day modified Rankin Scale (mRS) score. Mann-Whitney U test and multivariate logistic regression were performed to compare procedural parameters and clinical outcomes.ResultsConcurrent carotid revascularization (stenting with/without angioplasty) and MT was performed in 125 cases (BGC: 85; no BGC: 40). After PSM (40 patients/group), the BGC group had a significantly shorter procedure duration (77.9 vs 61.5 min; OR=0.996; P=0.006), lower discharge National Institutes of Health Stroke Scale score (8.0 vs 11.0; OR=0.987; P=0.042), and higher odds of 90-day mRS 0–2 score (52.3% vs 27.5%; OR=0.34; P=0.040). On multivariate regression, the BGC group had a significantly higher first pass effect rate (mTICI 2b or 3)(OR=1.115, 95% CI 1.015 to 1.432; P=0.013) and lower periprocedural sICH rate (OR=0.615, 95% CI 0.406 to 0.932; P=0.025). No difference in in-hospital mortality was observed (OR=1.591, 95% CI 0.976 to 2.593; P=0.067).ConclusionBGCs used for concurrent MT–carotid revascularization with flow arrest were safe and resulted in superior clinical and angiographic outcomes in patients with a tandem stroke.

A multi-center study of the MicroNET-covered stent in consecutive patients with acute carotid-related stroke: SAFEGUARD-STROKE

“…There is increasing understanding of the role of cerebral protection when performing EST in LVO strokes; this appears to be particularly relevant to CRS due to its generally large thrombus burden [ 57 ]. The STRATIS registry of over 500 patients indicated that the use of a balloon guide catheter versus a conventional catheter was an independent predictor of first-pass effect, modified first-pass effect (mTICI ≥ 2b) and functional independence [ 58 ].…”

“…The STRATIS registry of over 500 patients indicated that the use of a balloon guide catheter versus a conventional catheter was an independent predictor of first-pass effect, modified first-pass effect (mTICI ≥ 2b) and functional independence [ 58 ]. The recent propensity score-matched analysis of a series of tandem CRS by the Buffalo Group [ 57 ] demonstrated that the patients with a balloon guide catheter had a significantly shorter procedure duration, lower discharge NIHSS score, and higher odds of 90-day mRS 0-2. On multivariate regression, the balloon guide catheter cohort had a significantly higher first pass effect rate and lower periprocedural sICH rate.…”