Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Aug;42(8):1464-1471.
doi: 10.3174/ajnr.A7164. Epub 2021 May 27.

Clinical and Procedural Outcomes with or without Balloon Guide Catheters during Endovascular Thrombectomy in Acute Ischemic Stroke: A Systematic Review and Meta-analysis with First-line Technique Subgroup Analysis

A Podlasek  1   2   3 , P S Dhillon  2   3 , G Jewett  4 , A Shahein  4 , M Goyal  4   5 , M Almekhlafi  4   5
Affiliations
Meta-Analysis

Clinical and Procedural Outcomes with or without Balloon Guide Catheters during Endovascular Thrombectomy in Acute Ischemic Stroke: A Systematic Review and Meta-analysis with First-line Technique Subgroup Analysis

A Podlasek et al. AJNR Am J Neuroradiol. 2021 Aug.

Abstract

Background: Balloon guide catheters are increasingly used to improve clot retrieval by temporarily stopping proximal blood flow during endovascular thrombectomy.

Purpose: Our aim was to provide a summary of the literature comparing the procedural and clinical outcomes of endovascular thrombectomy with or without balloon guide catheters, depending on the first-line technique used.

Data sources: We used PubMed/MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews.

Study selection: We chose studies that compared using balloon guide catheters with not using them.

Data analysis: Random effects meta-analysis was performed to compare the procedural outcomes measured as the first-pass effect, successful reperfusion, number of passes, procedural duration, arterial puncture to reperfusion time, distal emboli, and clinical outcomes.

Data synthesis: Overall, a meta-analysis of 16 studies (5507 patients, 50.8% treated with balloon guide catheters and 49.2% without them) shows that the use of balloon guide catheters increases the odds of achieving a first-pass effect (OR = 1.92; 95% CI, 1.34-2.76; P < .001), successful reperfusion (OR = 1.85; 95% CI, 1.42-2.40; P < .001), and good functional outcome (OR =1.48; 95% CI, 1.27-1.73; P < .001). Balloon guide catheters reduce the number of passes (mean difference = -0.35; 95% CI, -0.65 to -0.04; P = .02), procedural time (mean difference = -19.73; 95% CI, -34.63 to -4.83; P = .009), incidence of distal or new territory emboli (OR = 0.5; 95% CI, 0.26-0.98; P = .04), and mortality (OR = 0.72; 95% CI, 0.62-0.85; P < .001). Similar benefits of balloon guide catheters are observed when the first-line technique was a stent retriever or contact aspiration, but not for a combined approach.

Limitations: The analysis was based on nonrandomized trials with a moderate risk of bias.

Conclusions: Current literature suggests improved clinical and procedural outcomes associated with the use of balloon guide catheters during endovascular thrombectomy, especially when using the first-line stent retriever.

PubMed Disclaimer

Figures

FIGURE.
FIGURE.
Clinical outcomes. This figure is a summary of random effects forest plots showing studies divided into the 3 groups depending on the first-line endovascular thrombectomy technique. A, Good functional outcome at 90 days. B, sICH. C, Mortality at 90 days. SR indicates stent retriever versus combined versus contact aspiration (CA).
See this image and copyright information in PMC

References

    1. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016;387:1723–31 10.1016/S0140-6736(16)00163-X - DOI - PubMed
    1. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke—a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019;50:E344–418 10.1161/STR.0000000000000211 - DOI - PubMed
    1. Turc G, Bhogal P, Fischer U, et al. European Stroke Organisation (ESO) – European Society for Minimally Invasive Neurological Therapy (ESMINT) Guidelines on Mechanical Thrombectomy in Acute Ischaemic Stroke Endorsed by Stroke Alliance for Europe (SAFE). Eur Stroke J 2019;4:6–12 10.1177/2396987319832140 - DOI - PMC - PubMed
    1. Deb-Chatterji M, Pinnschmidt H, Flottmann F, et al. Stroke patients treated by thrombectomy in real life differ from cohorts of the clinical trials: a prospective observational study. BMC Neurol 2020;20:81. 10.1186/s12883-020-01653-z - DOI - PMC - PubMed
    1. Ozdemir O, Giray S, Arlier Z, et al. Predictors of a good outcome after endovascular stroke treatment with stent retrievers. Scientific World Journal 2015;2015:403726. 10.1155/2015/403726] - DOI - PMC - PubMed

LinkOut - more resources