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Multicenter Study
. 2019 Mar;50(3):697-704.
doi: 10.1161/STROKEAHA.118.021126.

Impact of Balloon Guide Catheter Use on Clinical and Angiographic Outcomes in the STRATIS Stroke Thrombectomy Registry

Osama O Zaidat  1 , Nils H Mueller-Kronast  2 , Ameer E Hassan  3 , Diogo C Haussen  4   5 , Ashutosh P Jadhav  6 , Michael T Froehler  7 , Reza Jahan  8 , Mohammad Ali Aziz-Sultan  9 , Richard P Klucznik  10 , Jeffrey L Saver  8 , Frank R Hellinger Jr  11 , Dileep R Yavagal  12 , Tom L Yao  13 , Rishi Gupta  14 , Coleman O Martin  15 , Hormozd Bozorgchami  16 , Ritesh Kaushal  2 , Raul G Nogueira  5 , Ravi H Gandhi  11 , Eric C Peterson  12 , Shervin Dashti  13 , Curtis A Given 2nd  17 , Brijesh P Mehta  18 , Vivek Deshmukh  19 , Sidney Starkman  8 , Italo Linfante  20 , Scott H McPherson  21 , Peter Kvamme  22 , Thomas J Grobelny  23 , Muhammad Shazam Hussain  24 , Ike Thacker  25 , Nirav Vora  26 , Peng Roc Chen  27 , Stephen J Monteith  28 , Robert D Ecker  29 , Clemens M Schirmer  30 , Eric Sauvageau  31 , Alex Bou Chebl  32 , Colin P Derdeyn  33 , Lucian Maidan  34 , Aamir Badruddin  35 , Adnan H Siddiqui  36 , Travis M Dumont  37 , Abdulnasser Alhajeri  38 , Muhammad A Taqi  39 , Khaled Asi  40 , Jeffrey Carpenter  41 , Alan Boulos  42 , Gaurav Jindal  43 , Ajit S Puri  44 , Rohan Chitale  7 , Eric M Deshaies  45 , David Robinson  46 , David F Kallmes  47 , Blaise W Baxter  48 , Mouhammed Jumaa  49 , Peter Sunenshine  50 , Aniel Majjhoo  51 , Joey D English  52 , Shuichi Suzuki  53 , Richard D Fessler  54 , Josser Delgado-Almandoz  55 , Jerry C Martin  56 , David S Liebeskind  8 ; STRATIS Investigators
Affiliations
Multicenter Study

Impact of Balloon Guide Catheter Use on Clinical and Angiographic Outcomes in the STRATIS Stroke Thrombectomy Registry

Osama O Zaidat et al. Stroke. 2019 Mar.

Abstract

Background and Purpose- Mechanical thrombectomy has been shown to improve clinical outcomes in patients with acute ischemic stroke. However, the impact of balloon guide catheter (BGC) use is not well established. Methods- STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) was a prospective, multicenter study of patients with large vessel occlusion treated with the Solitaire stent retriever as first-line therapy. In this study, an independent core laboratory, blinded to the clinical outcomes, reviewed all procedures and angiographic data to classify procedural technique, target clot location, recanalization after each pass, and determine the number of stent retriever passes. The primary clinical end point was functional independence (modified Rankin Scale, 0-2) at 3 months as determined on-site, and the angiographic end point was first-pass effect (FPE) success rate from a single device attempt (modified Thrombolysis in Cerebral Infarction, ≥2c) as determined by a core laboratory. Achieving modified FPE (modified Thrombolysis in Cerebral Infarction, ≥2b) was also assessed. Comparisons of clinical outcomes were made between groups and adjusted for baseline and procedural characteristics. All participating centers received institutional review board approval from their respective institutions. Results- Adjunctive technique groups included BGC (n=445), distal access catheter (n=238), and conventional guide catheter (n=62). The BGC group had a higher rate of FPE following first pass (212/443 [48%]) versus conventional guide catheter (16/62 [26%]; P=0.001) and distal access catheter (83/235 [35%]; P=0.002). Similarly, the BGC group had a higher rate of modified FPE (294/443 [66%]) versus conventional guide catheter (26/62 [42%]; P<0.001) and distal access catheter (129/234 [55%]; P=0.003). The BGC group achieved the highest rate of functional independence (253/415 [61%]) versus conventional guide catheter (23/55 [42%]; P=0.007) and distal access catheter (113/218 [52%]; P=0.027). Final revascularization and mortality rates did not differ across the groups. Conclusions- BGC use was an independent predictor of FPE, modified FPE, and functional independence, suggesting that its routine use may improve the rates of early revascularization success and good clinical outcomes. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT02239640.

Keywords: animals; brain ischemia; humans; stroke; thrombectomy.

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