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Comparison of Balloon Guide Catheter and Non-Balloon Techniques in Middle Cerebral Artery (MCA) and Proximal M3
Wook-Joo Kim1, Shang Hun Shin2, Jung Min Choi2
1Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
Insights
Balloon guide catheters (BGCs) did not improve outcomes for M1 or distal middle cerebral artery occlusions during endovascular thrombectomy (EVT). BGC use was linked to lower first-pass recanalization and longer procedure times in acute ischemic stroke patients.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Stroke Medicine
Background:
- Balloon guide catheters (BGCs) are commonly used in endovascular thrombectomy (EVT) for large vessel occlusions.
- The specific benefits of BGCs in M1 or more distal middle cerebral artery (MCA) occlusions are not well-established.
Purpose of the Study:
- To evaluate the efficacy and safety of BGCs in patients with M1 or distal MCA occlusions undergoing EVT.
- To determine if BGC use influences recanalization rates, procedural times, and clinical outcomes.
Main Methods:
- Retrospective analysis of 61 acute ischemic stroke patients with M1-M3 occlusions undergoing EVT.
- Comparison of outcomes between patients treated with and without BGCs.
- Primary endpoints included successful recanalization, first-pass recanalization, and procedural time; secondary endpoints included functional outcomes and safety.
Main Results:
- No significant difference in successful recanalization rates between BGC and non-BGC groups (88.6% vs. 92.3%).
- Lower first-pass recanalization rates (42.9% vs. 69.2%) and longer procedural times (57.1 vs. 38.4 min) in the BGC group.
- No significant differences in 90-day functional independence, symptomatic hemorrhage, or mortality.
Conclusions:
- BGC use in M1 and distal MCA occlusions was not associated with improved angiographic or clinical outcomes.
- BGC use was linked to reduced first-pass recanalization and increased procedural times.
- Findings suggest a tailored approach to BGC selection based on occlusion location and procedural context.
Background:
While balloon guide catheters (BGCs) are widely used during endovascular thrombectomy (EVT) for large vessel occlusions, prior studies evaluated heterogeneous occlusion locations. The specific benefits of BGCs in M1, or more distal middle cerebral artery (MCA) occlusions remain uncertain.
Methods:
We retrospectively analyzed 61 patients with acute ischemic stroke due to M1, M2, or proximal M3 occlusion who underwent EVT at two tertiary centers between January 2020 and December 2021. Patients were treated using the stent retriever thrombectomy (SRT), direct aspiration first-pass technique (ADAPT), or combined techniques, with or without BGC, at the operator's discretion. Primary endpoints were successful recanalization (mTICI ≥2b), first-pass recanalization, and procedural time. Clinical outcomes included the 90-day modified rankin scale (mRS), symptomatic intracranial hemorrhage, and mortality.
Results:
Among the 61 patients (mean age 68.9 ± 12.8 years), 35 (57.4%) were treated with BGC. Successful recanalization rates were similar between the BGC and non-BGC groups (88.6% vs. 92.3%, P = 0.960). However, first-pass recanalization was lower in the BGC group (42.9% vs. 69.2%, P = 0.041), and procedural time was longer (57.1 ± 29.6 vs. 38.4 ± 19.7 min, P = 0.005). No significant differences were observed in functional independence at 90 days (40.0% vs. 50.0%, P = 0.440), symptomatic hemorrhage, or mortality. In multivariate logistic regression adjusting for age, baseline NIHSS, occlusion site, and recanalization success, BGC use was not independently associated with good functional outcome.
Conclusion:
In M1 and more distal MCA occlusions, BGC use was not associated with improved angiographic or clinical outcomes and was linked to lower first-pass recanalization rates and longer procedural times. These exploratory findings indicate that the utility of BGCs may depend on the occlusion location and procedural context, supporting a more tailored approach to device selection rather than a uniform preference for BGC use.
