Efficacy of Mechanical Thrombectomy Using Stent Retriever and Balloon-Guiding Catheter

Kammerer, Sarah; Rochemont, Richard du Mesnil de; Wagner, Marlies; You, Shoujiang; Tritt, Stephanie; Mueller-Eschner, Monika; Keil, Fee; Lauer, Arne; Berkefeld, Joachim

doi:10.1007/s00270-018-1901-8

Cited by 14 publications

(8 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…15 Additionally, the combination of a stentriever with PBGC has been previously reported as a feasible combinational approach, achieving first-pass recanalization in 110/170 (65%) of patients. 16 Consistent with these findings, we found that the use of PBGC was strongly associated with cFPE (mTICI 2c–3). Our findings support the concept that mTICI 2c and 3 may be a homogeneous group of patients where no (or less) distal emboli were produced during MT.…”

Section: Discussionsupporting

confidence: 88%

Procedural approaches and angiographic signs predicting first-pass recanalization in patients treated with mechanical thrombectomy for acute ischaemic stroke

et al. 2019

View full text Add to dashboard Cite

Background First-pass recanalization via mechanical thrombectomy (MT) has been associated with improved clinical outcome in patients with acute ischaemic stroke. The optimal approach to achieve first-pass effect (FPE) remains unclear. No study has evaluated angiographic features associated with the achievement of FPE. We aimed to determine the procedural approaches and angiographic signs that may predict FPE. Methods We performed a prospective, multi-centre, observational study of FPE in patients with anterior circulation stroke treated with MT between February and June 2017. MTs were performed using different devices, deployment manoeuvres (standard versus ‘Push and Fluff’ technique), proximal balloon guide catheter (PBGC), distal aspiration catheter (DAC) or both. The angiographic clot protrusion sign (ACPS) was recorded. Completed FPE (cFPE) was defined as a modified thrombolysis in cerebral infarction score of 2c–3. Associations were sought between cFPE and procedural approaches and angiographic signs. Results A total of 193 patients were included. cFPE was achieved in 74 (38.3%) patients. The use of the push and fluff technique (odds ratio (OR) 3.45, 95% confidence interval (CI): 1.28–9.29, p = 0.010), PBGC (OR 3.81, 95% CI: 1.41–10.22, p = 0.008) and ACPS (OR 4.71, 95% CI: 1.78–12.44, p = 0.002) were independently associated with cFPE. Concurrence of these three variables led to cFPE in 82 vs 35% of the remaining cases ( p = 0.002). Conclusions The concurrence of the PBGC, the push and fluff technique, and the ACPS was associated with the highest rates of cFPE. Appropriate selection of the thrombectomy device and deployment technique may lead to better procedural outcomes. ACPS could be used to assess clot integration strategies in future trials.

show abstract

Section: Discussionsupporting

confidence: 88%

Procedural approaches and angiographic signs predicting first-pass recanalization in patients treated with mechanical thrombectomy for acute ischaemic stroke

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Good clinical outcome at 3 months was higher in younger patients and those with lower NIHSS score at baseline, higher ASPECTS at admission, lower procedure time, fewer number of passes, and higher FPE rate. Good clinical outcome at 3 months was also more common in patients with lower NIHSS score at 24 hours [4 (IQR1-8) vs 16 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)] (table 3).…”

Section: Resultsmentioning

confidence: 99%

“…In this setting, previous studies have reported positive correlation between the use of a balloon guide catheter (BGC) and higher successful recanalization rates, shorter procedure times, better clinical outcomes, and lower risk of mortality. [12][13][14][15][16][17][18][19][20][21][22][23][24] As such, the use of BGCs is recommended in stent-retriever thrombectomy in current guidelines. 1 However, despite the preponderance of data in favor of BGC use, many neurointerventionists remain reluctant to use BGC due to different concerns including difficulty in navigating the device, the greater potential for groin complications due to the larger required femoral access, risk of carotid dissection, and compatibility of BGC with larger-bore distal aspiration catheters.…”

Section: Introductionmentioning

confidence: 99%

Balloon guide catheter improvements in thrombectomy outcomes persist despite advances in intracranial aspiration technology

Blasco

Puig

Daunis‐i‐Estadella

et al. 2021

J NeuroIntervent Surg

View full text Add to dashboard Cite

BackgroundFirst-pass effect (FPE) has been established as a key metric for technical success and strongly correlates with better clinical outcomes. Most data supporting improved outcomes with the use of a balloon guide catheter (BGC) predate the advent of last-generation large-bore intracranial aspiration catheters. We aim to evaluate the impact of BGC in FPE and clinical outcomes in a large cohort of patients treated with contemporary technology.MethodsPatients were recruited from the prospectively ongoing ROSSETTI registry. This registry includes all consecutive patients with anterior circulation large-vessel occlusion (LVO) from 10 comprehensive stroke centers in Spain. Demographic, clinical, angiographic, and clinical outcome data were compared between BGC and non-BGC groups. FPE was defined as the achievement of mTICI2c–3 after a single device pass.Results426 patients were included out of which 271 (63.62%) used BCG. BGC-treated patients had higher FPE rate (45.8% vs 27.7%; P<0.001), higher final mTICI ≥2 c recanalization rate (76.8% vs 50.3%, respectively; P<0.001), shorter procedural time [median (IQR), 30 (19–58) vs 43 (33–71) min; P<0.001], higher NIHSS difference from admission to 24 hours [median (IQR), 8 (2–12) vs 3 (0–10); P=0.001], and lower mortality rate (17.6% vs 29.8%, P=0.026) compared with non-BGC patients. BGC use was an independent predictor of FPE (OR 2.197, 95% CI 1.436 to 3.361; P<0.001), and excellent clinical outcome at 3 months (OR 0.34, 95% CI 0.17 to 0.68; P=0.002).ConclusionsOur results support the benefit of BGC use on angiographic and clinical outcomes in anterior circulation LVO ischemic stroke remain significant even when considering recent improvements in intracranial aspiration technology.

show abstract

“…The BGC allows for effective MT with an increased possibility of clot removal and reduced distal emboli, via proximal blood flow arrest and increasing suction effectiveness (9,10,18). The effect of proximal blood flow control in FG2 and Merci is considered to be the same, because they have same 8 F outer diameter and balloon size; however, the incidence rate of distal emboli was significantly lower in the FG2 group compared with the Merci group, and the use of FG2 was revealed to be associated with reduced distal emboli in the multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

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

Lee

Sung

2020

Exp Ther Med

View full text Add to dashboard Cite

show abstract

Efficacy of Mechanical Thrombectomy Using Stent Retriever and Balloon-Guiding Catheter

Abstract: Even a standard thrombectomy technique with the use of a stent retriever together with a balloon-guiding catheter provides reasonable recanalization rates with only one passage. The results can be taken as benchmark for alternative and more complex techniques.

Cited by 14 publications

References 47 publications

Procedural approaches and angiographic signs predicting first-pass recanalization in patients treated with mechanical thrombectomy for acute ischaemic stroke

Procedural approaches and angiographic signs predicting first-pass recanalization in patients treated with mechanical thrombectomy for acute ischaemic stroke

Balloon guide catheter improvements in thrombectomy outcomes persist despite advances in intracranial aspiration technology

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

Contact Info

Product

Resources

About