The initial experience with the Walrus balloon guide catheter - Results from two high-volume thrombectomy centres

BackgroundWe report our initial experience on the use of the Walrus, a new generation balloon guide catheter (BGC) capable of accommodating large bore aspiration catheters for patients undergoing endovascular stroke thrombectomy for large vessel occlusion with a particular focus on procedural aspects related to the vascular anatomy, recanalisation efficacy and complications.MethodsThis is a retrospective, site-adjudicated, two-centre study on consecutive patients with anterior circulation large vessel occlusion treated with the Walrus BGC. Baseline characteristics and procedural and clinical outcomes were analysed.ResultsBetween July 2023 and January 2024, we recruited 300 participants (mean age 69.5 ± 15 years; 132 (44%) females). The mean admission NIHSS was 15.8 ± 6.5, and the mean ASPECTS was 7.6 ± 1.9. Combined stent-retriever and aspiration first-line thrombectomy technique was performed in 235 patients (79%). The Walrus BGC was successfully navigated to the ICA in 99.7% of patients. Near complete-complete recanalisation (eTICI2c-3) was achieved in 75.4% of patients, and the eTICI2b-3 rate was 92.2%. First-pass effect (eTICI2c-3) was achieved in 49% of patients, and the modified first-pass effect (eTICI2b-3) was 65.9%. No significant difference in the arterial puncture-to-guide catheter placement time across the three different arch types (P = .52) or between the favourable and unfavourable ASMETS score (P = .085) was observed. Any intracranial haemorrhage (ICH) occurred in 14.9% of patients, and symptomatic ICH in 3.9%.ConclusionUse of the Walrus large bore BGC during endovascular stroke thrombectomy appears effective in reaching the target vessel without a significant time penalty across various anatomical configurations and tortuosity, whilst maintaining a satisfactory safety profile.