Effect of balloon guide catheter utilization on contact aspiration thrombectomy

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OBJECTIVE

The 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.

METHODS

All 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.

RESULTS

A 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).

CONCLUSIONS

BGC utilization significantly increased the final and first-pass recanalization rates and remained independently associated with recanalization success and good functional outcome.

ABBREVIATIONS ASPECTS = Alberta Stroke Program Early CT Score; BGC = balloon guide catheter; CAT = contact aspiration thrombectomy; CRF = case report form; EVT = endovascular thrombectomy; ICA = internal carotid artery; LVO = large vessel occlusion; MCA = middle cerebral artery; mRS = modified Rankin Scale; mTICI modified Thrombolysis in Cerebral Infarction; NIHSS = National Institutes of Health Stroke Scale; OPT = onset-to-puncture time; PRT = puncture-to-recanalization time; RCT = randomized controlled trial; tPA = tissue plasminogen activator.
Article Information

Contributor Notes

Correspondence Byung Moon Kim: Yonsei University College of Medicine, Seoul, South Korea. bmoon21@hanmail.net.INCLUDE WHEN CITING Published online November 23, 2018; DOI: 10.3171/2018.6.JNS181045.Disclosures The authors report no conflicts of interest concerning the materials or methods used in this study or the findings specified in this paper.
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