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Impact of Balloon Guide Catheters in Elderly Patients Treated with Mechanical Thrombectomy: Insights from the
Mikel Terceño1, Saima Bashir2, Josep Puig3
1From the Stroke Unit, Department of Neurology (M.T., S.B., J.S., Y.S.), Hospital Universitari Doctor Josep Trueta de, Girona, Girona Biomedical Research Institute, Girona, Spain.
Insights
Balloon guide catheters did not improve outcomes for elderly patients with large vessel occlusion stroke. This endovascular treatment did not enhance first-pass effect or functional independence in this population.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Geriatric Medicine
Background:
- Large-vessel occlusion (LVO) stroke in the anterior circulation is a critical condition.
- Balloon guide catheters (BGCs) show promise in LVO treatment, but their efficacy in elderly patients is understudied.
- Elderly patients (≥80 years) represent a vulnerable population with unique physiological considerations.
Purpose of the Study:
- To evaluate the effectiveness of BGCs in elderly patients (≥80 years) with anterior circulation LVO.
- To analyze the impact of BGCs on recanalization rates and functional outcomes in this specific demographic.
- To determine if BGC use is associated with improved first-pass effect and 3-month functional independence.
Main Methods:
- Retrospective analysis of 808 patients from the ROSSETTI Registry (June 2019-June 2022).
- Comparison of outcomes between patients treated with BGCs (n=465) and those without (n=343).
- Assessment of demographic data, clinical severity, endovascular techniques, and modified TICI scores (2c-3).
Main Results:
- Patients treated with BGCs were older, had higher neurological severity, and lower ASPECTS scores.
- No significant difference in the modified first-pass effect was observed between BGC and non-BGC groups (45.8% vs 39.9%, P=.096).
- Multivariable regression revealed no independent association between BGC use and improved first-pass effect, final recanalization (modified TICI 2c-3), or 3-month functional independence.
Conclusions:
- BGC use in elderly patients with anterior circulation LVO did not predict improved first-pass effect, recanalization, or functional independence.
- The findings suggest BGCs may not offer a significant advantage in this specific elderly cohort.
- Further research, including randomized controlled trials, is warranted to definitively establish the role of BGCs in older stroke patients.
Background And Purpose:
Several nonrandomized studies have demonstrated the effectiveness of balloon guide catheters in treating patients with anterior circulation large-vessel occlusion. However, their impact on the elderly populations has been underreported. We aimed to analyze the effect of balloon guide catheters in a cohort of elderly patients (80 years of age or older) with anterior circulation large-vessel occlusion.
Materials And Methods:
Consecutive patients from June 2019 to June 2022 were collected from the ROSSETTI Registry. Demographic and clinical data, angiographic endovascular technique, and clinical outcome were compared between balloon guide catheter and non-balloon guide catheter groups. We studied the association between balloon guide catheters and the rate of complete recanalization after a single first-pass effect modified TICI 2c-3, as well as their association with functional independence at 3 months.
Results:
A total of 808 patients were included during this period, 465 (57.5%) of whom were treated with balloon guide catheters. Patients treated with balloon guide catheters were older, had more neurologic severity at admission and lower baseline ASPECTS, and were less likely to receive IV fibrinolytics. No differences were observed in terms of the modified first-pass effect between groups (45.8 versus 39.9%, P = .096). In the multivariable regression analysis, balloon guide catheter use was not independently associated with a modified first-pass effect or the final modified TICI 2c-3, or with functional independence at 3 months.
Conclusions:
In our study, balloon guide catheter use during endovascular treatment of anterior circulation large-vessel occlusion in elderly patients did not predict the first-pass effect, near-complete final recanalization, or functional independence at 3 months. Further studies, including randomized clinical trials, are needed to confirm these results.
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