The Source for Neurovascular News and Education

November 29, 2022

 

New data from the TRACK registry show improved reperfusion, good clinical outcome, and lower mortality with the strategy versus a standard catheter.

 

Use of a balloon guide catheter (BGC) and Trevo stent retriever for large vessel occlusion (LVO) stroke is associated with better outcomes compared with conventional guide catheters, according to an analysis of the TRACK registry published online recently in the Journal of NeuroInterventional Surgery. These findings mirror those of a similar analysis that evaluated the benefits of using a BGC with the Solitaire stent retriever.

 

“It was important to conduct this study to see if the positive findings from the NASA BCG [North American Solitaire Acute Stroke Registry Balloon Guide Catheter] study on reperfusion and clinical outcomes in LVO stroke could be replicated,” lead author Thanh N. Nguyen, MD (Boston University School of Medicine, Boston, MA), senior author Osama O. Zaidat, MD (St. Vincent Mercy Medical Center, Toledo, OH), and co-author Alicia C. Castonguay, MD (University of Toledo, Toledo, OH), explained in a joint email to Neurovascular Exchange.

 

The NASA BCG study demonstrated faster reperfusion and procedure times as well as superior clinical outcomes with the use of a BGC in combination with the Solitaire stent retriever (Medtronic).

 

Using the TRACK registry data, Nguyen et al identified 536 patients with anterior circulation strokes who underwent endovascular thrombectomy using the Trevo stent retriever (Stryker). Of these patients, 52.1% underwent placement of a BGC. These latter patients were younger (mean 65.4 vs 68.1 years; P = 0.03) and had a trend toward less hypertension (72% vs 79%; P = 0.06) than those who were treated using a conventional guide catheter.

 

There also was a trend toward a longer duration of time from symptom onset to groin puncture among patients treated with BGC. In addition, use of these catheters was associated with a greater likelihood of achieving a TICI 2b/3 as well as a 90-day good clinical outcome. Mortality rates were also lower with use of BGC.

 

Procedural, Reperfusion, and Clinical Outcomes

 

BGC

(n = 279)

No BGC

(n = 257)

P Value

Mean Time From Symptom Onset to Puncture, min

357

319

0.06

TICI ≥ 2b

84.2%

75.5%

0.01

90-Day mRS ≤ 2

56.5%

40.4%

0.0004

90-Day Mortality

13.4%

23%

0.008

 

There was no difference in reperfusion time, first pass effect, number of passes, or rescue therapy between patients treated with and without balloon guide catheters.

 

In multivariate analysis, balloon guide catheter use was an independent predictor of good clinical outcome (OR 2; 95% CI 1.3-3.1; P = 0.001).

 

“For patients who present with large vessel occlusion ischemic stroke, use of a balloon guide catheter with [a] stent retriever results in improved reperfusion and clinical outcome compared to [a] conventional guide catheter,” the authors stated to NVX.

 

They recommended that caution be taken when interpreting the findings, however, since the trial was nonrandomized. “We did not have complete data capture on use of intermediate aspiration catheters and whether this made a difference or not,” they reported, adding, “There are many different techniques being used with well-published and reported success. It would be best for neurointerventionalists to look at the BGC data from both NASA and TRACK and let the data speak for themselves.”

 



Source:

Nguyen TN, Castonguay AC, Nogueira RG, et al. Effect of balloon guide catheter on clinical outcomes and reperfusion in Trevo thrombectomy. J NeuroIntervent Surg. 2019;Epub ahead of print.

 

Disclosures:

  • This study was supported by a limited coordinating center administrative grant from Stryker Neurovascular.
  • Nguyen reports being a consultant to Medtronic.
  • Zaidat reports being a consultant/advisory board member for Stryker Neurovascular and Covidien.