Effect of balloon guide catheter on clinical outcomes and reperfusion in Trevo thrombectomy

Abstract

IntroductionThe Solitaire stent retriever registry showed improved reperfusion, faster procedure times, and better outcome in acute stroke patients with large vessel occlusion treated with a balloon guide catheter (BGC) and Solitaire stent retriever compared with a conventional guide catheter. The goal of this study was to evaluate whether use of a BGC with the Trevo stent retriever improves outcomes compared with a conventional guide catheter.MethodsThe TRACK registry recruited 23 sites to submit demographic, clinical, and site adjudicated angiographic and outcome data on consecutive patients treated with the Trevo stent retriever. BGC use was at the discretion of the physician.Results536 anterior circulation patients (of whom 279 (52.1%) had BGC placement) were included in this analysis. Baseline characteristics were notable for younger patients in the BGC group (65.4±15.3 vs 68.1±13.6, P=0.03) and lower rate of hypertension (72% vs 79%, P=0.06). Mean time from symptom onset to groin puncture was longer in the BGC group (357 vs 319 min, P=0.06).Thrombolysis in Cerebral Infarction 2b/3 scores were higher in the BGC cohort (84% vs 75.5%, P=0.01). There was no difference in reperfusion time, first pass effect, number of passes, or rescue therapy. Good clinical outcome at 3 months was superior in patients with BGC (57% vs 40%; P=0.0004) with a lower mortality rate (13% vs 23%, P=0.008). Multivariate analysis demonstrated that BGC use was an independent predictor of good clinical outcome (OR 2; 95% CI 1.3 to 3.1, P=0.001).ConclusionsIn acute stroke patients presenting with anterior circulation large vessel occlusion, use of a BGC with the Trevo stent retriever resulted in improved reperfusion, improved clinical outcome, and lower mortality.

Predictors of Successful First-Pass Thrombectomy with a Balloon Guide Catheter: Results of a Decision Tree Analysis

“…In agreement with previous studies, complete recanalization (mTICI 3, 62.5%) was commonly achieved in our series [ 18 ]. Nevertheless, the reported rates of complete recanalization using BGC have ranged from 15 to 63% [ 8 , 19 , 20 ]. We believe that these differences can be accounted for in part by differences in BGC use in the patients in these studies.…”

“…Consequently, identifying anatomical determining factors restricting the effectiveness of MT represents an initial step towards adapting the endovascular strategy and techniques to the anatomical conditions of patients for more efficient clot extraction. While one study did report target location in the distal ICA [ 8 ], specific BGC positioning for mechanical thrombectomy has seldom been described [ 5 , 7 , 18 – 20 ]. Our study revealed an efficacy gradient depending on the location of the BGC in the carotid artery, consistent with the results of Jeong et al [ 13 ] (TICI 3 irrespective of passes in 67% of the distal BGC group versus 45% for the proximal BGC group).…”

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).…”