Effect of balloon guide catheter utilization on contact aspiration thrombectomy

Abstract

OBJECTIVEThe role of the balloon guide catheter (BGC) has not been evaluated in contact aspiration thrombectomy (CAT) for acute stroke. Here, the authors aimed to test whether the BGC was associated with recanalization success and good functional outcome in CAT.METHODSAll patients who had undergone CAT as the first-line treatment for anterior circulation intracranial large vessel occlusion were retrospectively identified from prospectively maintained registries for six stroke centers. The patients were dichotomized into BGC utilization and nonutilization groups. Clinical findings, procedural details, and recanalization success rates were compared between the two groups. Whether the BGC was associated with recanalization success and functional outcome was assessed.RESULTSA total of 429 patients (mean age 68.4 ± 11.4 years; M/F ratio 215:214) fulfilled the inclusion criteria. A BGC was used in 45.2% of patients. The overall recanalization and good outcome rates were 80.2% and 52.0%, respectively. Compared to the non-BGC group, the BGC group had a significantly reduced number of CAT passes (2.6 ± 1.6 vs 3.4 ± 1.5), shorter puncture-to-recanalization time (56 ± 27 vs 64 ± 35 minutes), lower need for the additional use of thrombolytics (1.0% vs 8.1%), and less embolization to a distal or different site (0.5% vs 3.4%). The BGC group showed significantly higher final (89.2% vs 72.8%) and first-pass (24.2% vs 8.1%) recanalization success rates. After adjustment for potentially associated factors, BGC utilization remained independently associated with recanalization (OR 4.171, 95% CI 1.523–11.420) and good functional outcome (OR 2.103, 95% CI 1.225–3.612).CONCLUSIONSBGC utilization significantly increased the final and first-pass recanalization rates and remained independently associated with recanalization success and good functional outcome.

Effects of first pass recanalization on outcomes of contact aspiration thrombectomy

“…Finally, the role of BGC use was confirmed as the only independent predictor of FPR in these frontline CAT data. As mentioned earlier, this result concurred with previous studies that used frontline SRT 14 26–29. A recent meta-analysis focusing on the impact of BGC on outcomes showed that BGC use during EVT was associated with superior clinical (higher mRS 0–2) and angiographic outcomes (higher FPR, TICI 2b/3, lower number of passes, mortality, and shorter procedure time) 33.…”

“…Considering that the key elements of CAT are ‘clot contact’ and ‘aspiration force’, a larger luminal diameter can theoretically increase the contact area and generate a more intense aspiration force,25 which may result in a higher incidence of FPR in the COMPASS trial 14. Additionally, BGC use was consistently associated with FPR in previous frontline SRT studies and in the present study 14 26–29…”

Role of Balloon Guide Catheter in Modern Endovascular Thrombectomy

“…A recent analysis compared data of the BGC and the CGC groups in frontline CAT cases using a Korean multi-center registry 25) . In the study, a total of 429 patients were enrolled, with the BGC used in 45.2% of patients.…”

“…Recently, stent retrievermediated mechanical thrombectomy (SR-MT) is considered the standard-of-care for selected patients with acute LVO in the anterior circulation due to positive results of recent five randomized clinical trials (RCT) 2,4,16,22,52) . 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) .…”

“…Regarding the use of BGC during ADAPT, there is a concern about the compromised efficacy of aspiration due to the limitation of the size of aspiration catheter that can be used with the limited inner diameter of the BGC. However, in real practice, some neurointerventionalists have used BGC during ADAPT and have reported the positive role of BGC compared to CGCs 25,57) . In addition to lowering the risk of distal embolization, shorter procedure time and higher rate of first-pass success as well as better clinical outcomes are further benefits of using BGCs versus non-BGCs, which will be discussed later in this paper 40,44,64,69) .…”