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. 2021 Jun;163(6):1787-1797.
doi: 10.1007/s00701-021-04787-2. Epub 2021 Mar 15.

Usefulness of combination usage of balloon guide catheter with contact aspiration thrombectomy

Yong-Won Kim #  1 , Dong-Hun Kang #  2   3 , Wonsoo Son  2 , Yang-Ha Hwang  1 , Yong-Sun Kim  3 , Jong Wook Shin  4 , Jeong-Wook Lim  5 , Hyeon-Song Koh  5 , Hyon-Jo Kwon  6
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Usefulness of combination usage of balloon guide catheter with contact aspiration thrombectomy

Yong-Won Kim et al. Acta Neurochir (Wien). 2021 Jun.

Abstract

Background: Angiographic outcomes of contact aspiration thrombectomy (CAT), a frontline thrombectomy strategy, can vary depending on balloon guide catheter (BGC) usage, stroke etiology, and occlusion location. The purpose of this study was to analyze conditional outcomes of CAT to determine which result in maximum angiographic benefits.

Methods: Patients who received CAT for anterior circulation occlusive stroke between January 2017 and December 2018 were included. Angiographic and clinical outcomes were compared relative to BGC use, stroke etiology, and occlusion location. Multivariable analyses for first-pass reperfusion (FPR) and favorable clinical outcome were performed.

Results: Of 160 included patients, the rates of FPR, successful reperfusion after CAT, final successful reperfusion, and favorable clinical outcome were 43.1%, 58.1%, 81.9%, and 60.6%, respectively. BGC use was associated with a higher rate of FPR, successful reperfusion after CAT, a lower rate of distal embolization, and faster reperfusion. Based on subgroup analysis, BGC usage in ICA, MCA M1 occlusion, and cardioembolism were associated with higher FPR, successful reperfusion after CAT, and lower distal embolization. Faster reperfusion was achieved in ICA occlusions and cardioembolisms. BGC usage was an independent predictor of FPR. Favorable clinical outcome was associated with male gender, low initial NIHSS score, fast onset to reperfusion, and FPR.

Conclusions: In CAT, BGC usage was associated with better angiographic outcomes, including higher FPR, successful reperfusion after CAT, prevention of distal embolization, and faster reperfusion, especially in proximal occlusions and cardioembolisms. These conditions may play a role in maximizing the benefits of CAT.

Keywords: Acute ischemic stroke; Balloon guide catheter; Contact aspiration thrombectomy; Occlusion location; Stroke etiology.

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