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Current Neurovascular Research

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ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

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Research Article

Effect of Early Balloon Inflation of Balloon Guide Catheter in Mechanical Thrombectomy for Large Vessel Occlusion

Author(s): Beom Mo Kang, Ho Jun Yi*, Dong-Seong Shin and Bum-Tae Kim

Volume 20, Issue 1, 2023

Published on: 10 April, 2023

Page: [124 - 131] Pages: 8

DOI: 10.2174/1567202620666230404125627

Price: $65

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Abstract

Objective: A balloon guide catheter (BGC) is widely used in mechanical thrombectomy (MT). However, the balloon inflation timing of BGC has not been clearly established. We evaluated whether balloon inflation timing of BGC affects the results of MT.

Methods: Patients who underwent MT with BGC for anterior circulation occlusion were enrolled. Patients were dichotomized into early and late balloon inflation groups, according to the timing of BGC inflation. Angiographic and clinical outcomes were compared between the two groups. Multivariable analyses were performed to evaluate the predictive factors for first-pass reperfusion (FPR) and successful reperfusion (SR).

Results: Of 436 patients, the early balloon inflation group showed a shorter procedure time (21 min (11-37) vs. 29 min (14-46), p = 0.014), a higher rate of SR with aspiration only (64.0% vs. 55.4%, p = 0.016), a lower aspiration catheter delivery failure rate (11.1% vs. 19.4%, p = 0.005), less frequent technique conversion (36.0% vs. 44.5%, p = 0.009), higher rate of FPR (58.2% vs. 50.2%, p = 0.011), and a lower rate of distal embolization (7.9% vs. 11.7%, P = 0.006), compared to the late balloon inflation group. In multivariate analysis, early balloon inflation was an independent predictor for FPR (odds ratio, OR 1.53, 95% confidence interval, CI 1.37–2.57; p = 0.011) and SR (OR 1.26, 95% CI 1.18-1.64; p = 0.018).

Conclusion: Early balloon inflation of BGC enables an effective procedure than late balloon inflation. Early balloon inflation was associated with higher rates of FPR and SR.

Keywords: Balloon occlusion, ischemic stroke, intervention, reperfusion, thrombectomy, balloon inflation.

« Previous Next »
[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(10029): 1723-31.
[http://dx.doi.org/10.1016/S0140-6736(16)00163-X] [PMID: 26898852]
[2]
Berkhemer OA, Fransen PSS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372(1): 11-20.
[http://dx.doi.org/10.1056/NEJMoa1411587] [PMID: 25517348]
[3]
Campbell BCV, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372(11): 1009-18.
[http://dx.doi.org/10.1056/NEJMoa1414792] [PMID: 25671797]
[4]
Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372(11): 1019-30.
[http://dx.doi.org/10.1056/NEJMoa1414905] [PMID: 25671798]
[5]
Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372(24): 2296-306.
[http://dx.doi.org/10.1056/NEJMoa1503780] [PMID: 25882510]
[6]
Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372(24): 2285-95.
[http://dx.doi.org/10.1056/NEJMoa1415061] [PMID: 25882376]
[7]
Lapergue B, Blanc R, Gory B, et al. Effect of endovascular contact aspiration vs stent retriever on revascularization in patients with acute ischemic stroke and large vessel occlusion. JAMA 2017; 318(5): 443-52.
[http://dx.doi.org/10.1001/jama.2017.9644] [PMID: 28763550]
[8]
Turk AS III, Siddiqui A, Fifi JT, et al. Aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion (COMPASS): A multicentre, randomised, open label, blinded outcome, non-inferiority trial. Lancet 2019; 393(10175): 998-1008.
[http://dx.doi.org/10.1016/S0140-6736(19)30297-1] [PMID: 30860055]
[9]
Deshaies EM. Tri-axial system using the solitaire-FR and Penumbra Aspiration Microcatheter for acute mechanical thrombectomy. J Clin Neurosci 2013; 20(9): 1303-5.
[http://dx.doi.org/10.1016/j.jocn.2012.10.037] [PMID: 23835465]
[10]
Yi HJ, Sung JH, Lee DH, Song SY. Effectiveness and technical considerations of solitaire platinum 4×40 mm stent retriever in mechanical thrombectomy with solumbra technique. J Korean Neurosurg Soc 2021; 64(1): 30-8.
[http://dx.doi.org/10.3340/jkns.2020.0046] [PMID: 32759627]
[11]
Baek JH, Kim BM, Kang DH, et al. Balloon guide catheter is beneficial in endovascular treatment regardless of mechanical recanalization modality. Stroke 2019; 50(6): 1490-6.
[http://dx.doi.org/10.1161/STROKEAHA.118.024723] [PMID: 31043149]
[12]
Kim YW, Kang DH, Son W, et al. Usefulness of combination usage of balloon guide catheter with contact aspiration thrombectomy. Acta Neurochir 2021; 163(6): 1787-97.
[http://dx.doi.org/10.1007/s00701-021-04787-2] [PMID: 33723972]
[13]
Chueh JY, Kang DH, Kim BM, Gounis MJ. Role of balloon guide catheter in modern endovascular thrombectomy. J Korean Neurosurg Soc 2020; 63(1): 14-25.
[http://dx.doi.org/10.3340/jkns.2019.0114] [PMID: 31591997]
[14]
Chueh JY, Kühn AL, Puri AS, et al. Reduction in distal emboli with proximal flow control during mechanical thrombectomy: A quantitative in vitro study. Stroke 2013; 44(5): 1396-401.
[http://dx.doi.org/10.1161/STROKEAHA.111.670463] [PMID: 23493730]
[15]
Velasco A, Buerke B, Stracke CP, et al. Comparison of a balloon guide catheter and a non–balloon guide catheter for mechanical thrombectomy. Radiology 2016; 280(1): 169-76.
[http://dx.doi.org/10.1148/radiol.2015150575] [PMID: 26789499]
[16]
Yi HJ, Sung JH, Lee MH, Lee DH. Experience of the new flowgate2 device as a balloon guide catheter for ischemic stroke intervention. World Neurosurg 2019; 126: e736-42.
[http://dx.doi.org/10.1016/j.wneu.2019.02.140] [PMID: 30851472]
[17]
Suh CH, Lee YJ. Recent trend for endovascular treatment in patients with acute ischemic stroke: Balloon guide catheter. Neurointervention 2019; 14(2): 142-3.
[http://dx.doi.org/10.5469/neuroint.2019.00136] [PMID: 31409062]
[18]
Kang DH, Kim BM, Heo JH, et al. Effect of balloon guide catheter utilization on contact aspiration thrombectomy. J Neurosurg 2018; 131(5): 1494-500.
[http://dx.doi.org/10.3171/2018.6.JNS181045] [PMID: 30497154]
[19]
Stampfl S, Pfaff J, Herweh C, et al. Combined proximal balloon occlusion and distal aspiration: A new approach to prevent distal embolization during neurothrombectomy. J Neurointerv Surg 2017; 9(4): 346-51.
[http://dx.doi.org/10.1136/neurintsurg-2015-012208] [PMID: 27056920]
[20]
Liu H, Jia R, He Y, et al. Safety and efficacy of the SeparGateTM balloon-guiding catheter in neurointerventional surgery: A prospective, multicenter, single-arm clinical trial. J Int Med 2022; 5(3): 143-7.
[http://dx.doi.org/10.1016/j.jimed.2022.06.003] [PMID: 36317147]
[21]
Yi HJ, Sung JH, Lee DH. Bridging intravenous thrombolysis before mechanical thrombectomy for large artery occlusion may be detrimental with thrombus fragmentation. Curr Neurovasc Res 2020; 17(1): 18-26.
[http://dx.doi.org/10.2174/1567202617666191223143831] [PMID: 31870263]
[22]
Yi HJ, Kim BT, Shin DS. Effectiveness of anchoring with balloon guide catheter and stent retriever in difficult mechanical thrombectomy for large vessel occlusion. J Korean Neurosurg Soc 2022; 65(4): 514-22.
[http://dx.doi.org/10.3340/jkns.2021.0158] [PMID: 35728980]
[23]
Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359(13): 1317-29.
[http://dx.doi.org/10.1056/NEJMoa0804656] [PMID: 18815396]
[24]
Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. Classification of stroke subtypes. Cerebrovasc Dis 2009; 27(5): 493-501.
[http://dx.doi.org/10.1159/000210432] [PMID: 19342825]
[25]
Dargazanli C, Fahed R, Blanc R, et al. Modified thrombolysis in cerebral infarction 2c/thrombolysis in cerebral infarction 3 reperfusion should be the aim of mechanical thrombectomy. Stroke 2018; 49(5): 1189-96.
[http://dx.doi.org/10.1161/STROKEAHA.118.020700] [PMID: 29626134]
[26]
Maus V, Brehm A, Tsogkas I, Henkel S, Psychogios MN. Stent retriever placement in embolectomy: the choice of the post-bifurcational trunk influences the first-pass reperfusion result in M1 occlusions. J Neurointerv Surg 2019; 11(3): 237-40.
[http://dx.doi.org/10.1136/neurintsurg-2018-014114] [PMID: 30054319]
[27]
Blasco J, Puig J, Daunis-i-Estadella P, et al. Balloon guide catheter improvements in thrombectomy outcomes persist despite advances in intracranial aspiration technology. J Neurointerv Surg 2021; 13(9): 773-8.
[http://dx.doi.org/10.1136/neurintsurg-2020-017027] [PMID: 33632881]
[28]
Shah VA, Martin CO, Hawkins AM, Holloway WE, Junna S, Akhtar N. Groin complications in endovascular mechanical thrombectomy for acute ischemic stroke: A 10-year single center experience. J Neurointerv Surg 2016; 8(6): 568-70.
[http://dx.doi.org/10.1136/neurintsurg-2015-011763] [PMID: 26002302]
[29]
Teo YN, Sia CH, Tan BYQ, et al. Combined balloon guide catheter, aspiration catheter, and stent retriever technique versus balloon guide catheter and stent retriever alone technique: A systematic review and meta-analysis. J Neurointerv Surg 2023; 15(2): 127-32.
[http://dx.doi.org/10.1136/neurintsurg-2021-018406] [PMID: 35101960]
[30]
Cappuzzo JM, Monteiro A, Waqas M, et al. Carotid artery stenting using the walrus balloon guide catheter with flow reversal for proximal embolic protection: Technical description and single-center case series. Oper Neurosurg 2023; 24(1): 11-6.
[http://dx.doi.org/10.1227/ons.0000000000000442] [PMID: 36251417]
[31]
Salem MM, Kvint S, Baig AA, et al. Carotid artery revascularization using the Walrus balloon guide catheter: Safety and feasibility from a US multicenter experience. J Neurointerv Surg 2022; 14(7): 709-17.
[http://dx.doi.org/10.1136/neurintsurg-2021-018126] [PMID: 34686574]
[32]
Yi HJ, Sung JH, Lee DH, Shin DS, Kim BT. Factors related to mechanical thrombectomy failure in large vessel occlusion: A propensity score matching analysis. Curr Neurovasc Res 2022; 19(4): 427-34.
[http://dx.doi.org/10.2174/1567202620666221103101512] [PMID: 36330622]
[33]
Sharashidze V, Nogueira RG, Al-Bayati AR, Grossberg JA, Haussen DC. Balloon anchoring technique for thrombectomy in hostile craniocervical arterial anatomy. J Neurointerv Surg 2020; 12(8): 763-7.
[http://dx.doi.org/10.1136/neurintsurg-2019-015347] [PMID: 32015181]

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