The advantages of using the devices appear to outweigh the disadvantages, a retrospective analysis hints.
Use of balloon guide catheters during contact aspiration for acute ischemic stroke increases the final and first-pass recanalization rates, according to a retrospective analysis published online November 23, 2018, ahead of print, in the Journal of Neurosurgery. The devices also are independently linked to recanalization success and good functional outcome.
In vitro and animal models of stroke have shown that flow arrest using a balloon guide catheter reduces the risk of embolization and increases the flow reversal effect during endovascular thrombectomy, write the authors led by Dong-Hun Kang, MD (Kyungpook National University, Daegu, South Korea).
In addition, two recent clinical studies have demonstrated greater recanalization success rates and shorter procedure times with the use of balloon guide catheters during stent retriever thrombectomy. To date, however, only one small study of 31 patients has evaluated use of balloon guide catheters in combination with contact aspiration.
For the new study, all 429 patients (mean age 68.4 years; 50.1% men) who had undergone contact aspiration thrombectomy as the first-line treatment for anterior circulation intracranial large vessel occlusion were retrospectively identified from prospectively-maintained registries for six stroke centers. A balloon guide catheter was used in 45.2%.
The overall recanalization rate, defined as a modified TIC 2b-3, was 80.2%. A good outcome, defined as a 90-day mRS 0-2, was attained by 52.0% of patients.
Use of balloon guide catheters was associated with significantly higher rates of final and first-pass successful recanalization. In addition, patients who were treated using this strategy had a significantly reduced number of catheter passes and a shorter puncture-to-recanalization time, and they were less likely to require additional thrombolytics and to experience embolization to a distal or different site.
Outcomes Based on Use of Balloon Guide Catheter
|
|
With (n = 194) |
Without (n = 235) |
P Value |
|
Final Successful Recanalization |
89.2% |
72.8% |
< 0.001 |
|
First-Pass Successful Recanalization |
24.2% |
8.1% |
< 0.001 |
|
Number of Passes |
2.6 ± 1.6 |
3.4 ± 1.5 |
< 0.001 |
|
Puncture-to-Recanalization Time, min |
56 ± 27 |
64 ± 35 |
0.018 |
|
Need for Additional Thrombolysis |
1.0% |
8.1% |
0.001 |
|
Embolization to Distal/Different Site |
0.5% |
3.4% |
0.045 |
After adjustment for potential confounders, use of balloon guide catheters was found to be an independent predictor of successful recanalization (OR 4.17; 95% CI 1.52-11.42) and good functional outcome (OR 2.10; 95% CI 1.23-3.61).
Patients treated using a balloon guide catheter had a nonsignificant increase in tandem occlusion, which in turn was independently associated with poor outcome in the study. Nevertheless, the authors conclude that the advantages of balloon guide catheters appear to outweigh the disadvantages.
“The results of this study may be helpful in the setting of endovascular therapy for acute stroke and may provide baseline data for further prospective study designs,” they write.
Source:
Kang D-H, Kim BM, Heo JH, et al. Effect of balloon guide catheter utilization on contact aspiration thrombectomy. J Neurosurg. 2018;Epub ahead of print.
Disclosures:
Kang reports no relevant conflicts of interest.
