Temporary flow arrest using EMBOGUARD™ balloon guide catheter may improve functional outcomes in acute stroke...

Balloon guide catheters (BGCs) have demonstrated benefits in mechanical thrombectomy (MT) for acute ischemic stroke (AIS), including improved recanalization rates and reduced distal embolization. The EMBOGUARD™ balloon guide catheter (Johnson & Johnson Neurovascular, Irvine, CA) represents a novel design with enhanced flexibility and compatibility with large-bore aspiration catheters. This study aims to evaluate the safety and efficacy of the EMBOGUARD™ BGC compared with non-BGC approaches.

We conducted a retrospective multicenter study to analyze patients with AIS due to anterior large vessel occlusions (LVOs) who underwent MT between January 2022 and December 2024. Patients were divided into two groups: those treated with t☺he EMBOGUARD™ BGC and those treated without BGC. Primary outcomes included first-pass effect (FPE), successful recanalization (mTICI ≥2b), procedural time, number of passes, and distal embolization. Secondary outcomes included 90-day functional outcome (modified Rankin Scale [mRS] 0-2), mortality, and symptomatic intracranial hemorrhage (sICH).

A total of 178 patients were included (EMBOGUARD: n = 135, 75.8%; non-BGC: n = 43, 24.2%). The EMBOGUARD™ group demonstrated comparable rates of FPE (33.3% vs. 37.2%, p = 0.68) and successful recanalization (86.7% vs. 86.0%, p = 0.92). Procedural time was significantly shorter in the EMBOGUARD™ group (median 32 min vs. 49 min, p = 0.004). Distal embolization rates were similar between groups (4.4% vs. 4.7%, p = 1.00). The EMBOGUARD™ group showed significantly higher rates of favorable functional outcome at 90 days (48.6% vs. 28.1%, p = 0.04) and non-significantly lower 90-day mortality (13.7% vs. 16.7%, p = 0.6). Although favorably trending, multivariate logistic regression analysis did not confirm that EMBOGUARD™ was associated with greater odds of FPE (adjusted odds ratio [aOR] 2.01, 95% confidence interval [CI] 0.65-6.41, p = 0.2), mRS 0-2 at 90 days (aOR 1.36, 95% CI 0.35-5.34, p = 0.7) or lower odds of mortality at 90 days (aOR 0.32, 95% CI 0.05-1.85, p = 0.2).

The EMBOGUARD™ balloon guide catheter demonstrated comparable technical efficacy with reduced procedural times and improved clinical outcomes compared with non-BGC techniques in endovascular thrombectomy for acute ischemic stroke. These findings support the use of EMBOGUARD™ as a reasonable tool for flow arrest in stroke intervention.