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Pederson JM, Hardy N, Lyons H, Sheffels E, Touchette JC, Brinjikji W, Kallmes DF, Kallmes KM. Comparison of Balloon Guide Catheters and Standard Guide Catheters for Acute Ischemic Stroke: An Updated Systematic Review and Meta-analysis. World Neurosurg 2024; 185:26-44. [PMID: 38296042 DOI: 10.1016/j.wneu.2024.01.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/21/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The objective of this study was to update our 2021 systematic review and meta-analysis which reported that balloon guide catheters (BGC) are associated with superior clinical and angiographic outcomes compared to standard guide catheters for treatment of acute ischemic stroke. METHODS We conducted a systematic review of 7 electronic databases to identify literature published between January 2010 and September 2023 reporting BGC versus non-BGC approaches. Primary outcomes were final modified thrombolysis in cerebral infarction (mTICI) ≥2b, first-pass effect (mTICI ≥2c on first pass), and modified Rankin scale 0-2 at 90 days. The risk of bias was assessed using the Newcastle Ottawa Scale. A separate random effects model was fitted for each outcome. Subgroup analyses by first-line approach were conducted. RESULTS Twenty-four studies comprising 8583 patients were included (4948 BGC; 3635 non-BGC; 1561 BGC + Stent-retriever; 1297 non-BGC + Stent-retriever). Nine studies had low risk of bias, 3 were moderate risk, and 12 were high risk. Patients treated with BGCs had higher odds of achieving mTICI 2b/3, first-pass effect mTICI 2c/3, and modified Rankin scale 0-2 at 90 days (P < 0.001). The number of patients needed to treat in order to achieve one additional successful recanalization is 17. BGC + Stent-retriever was associated with higher odds of mTICI≥2b, 90-day modified Rankin scale 0-2, and reduced odds of 90-day mortality compared to non-BGC + Stent-retrievers. The main limitation was the absence of randomized trials. CONCLUSIONS These findings corroborate our previous results suggesting that MT using BGCs is associated with better safety and effectiveness outcomes for acute ischemic stroke, especially BGC + Stent-retrievers.
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Affiliation(s)
- John M Pederson
- Superior Medical Experts, St. Paul, Minnesota, USA; Nested Knowledge, Inc, St. Paul, Minnesota, USA.
| | - Nicole Hardy
- Superior Medical Experts, St. Paul, Minnesota, USA
| | - Hannah Lyons
- Superior Medical Experts, St. Paul, Minnesota, USA
| | | | | | | | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin M Kallmes
- Superior Medical Experts, St. Paul, Minnesota, USA; Nested Knowledge, Inc, St. Paul, Minnesota, USA
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Bajrami A, Geyik S, Ertugrul O, Erdem E, Gallego Leon JI, Barbieri G, Dominguez Rodriguez C, Rayón-Aledo JC, Barra AIS, Blanco FSS, Candel CS, Montalverne FJ, Andrade LI, Bandeira D, Bezerra J, Carm H, Silva HC, Braga Cruz Guedes de Morais A, de Lucena AF, Lima FO, Mendes G, Rocha FA, Kupcs K, Kidikas H, Vetra J, Gal G, Diaz A, Nogueira RG. Rapidpulse TM cyclic aspiration system for acute ischemic stroke due to large vessel occlusions. Interv Neuroradiol 2024:15910199241239094. [PMID: 38515399 DOI: 10.1177/15910199241239094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The best strategy to achieve optimal reperfusion outcomes during mechanical thrombectomy remains to be defined. The RapidPulseTM Cyclic Aspiration System is a novel technology, delivering high-frequency pulsed vacuum forces to increase the efficiency of aspiration thrombectomy. METHODS Prospective, multicenter, open-label, core lab-adjudicated, two-arm study comparing safety and efficacy of a feasibility version of the RapidPulseTM system compared with contemporary controls. Primary endpoint was the rate of mTICI ≥ 2c after first-pass effect (FPE). Additional efficacy endpoints were the rates of mTICI ≥ 2b after first pass (modified FPE (mFPE)), last pass with study device defined as frontline technical success, and after all passes including rescue therapy. The primary safety endpoints included symptomatic ICH (sICH) within 24 h post-procedure. RESULTS Between February 2022 to December 2022, 80 subjects were consented and enrolled in the study (n = 40 treatment arm, n = 40 control arm). In the intent to treat (ITT) population, mean age was 67.8 ± 11.5 years; 19 (47.5%) were male. Median NIHSS score was 16 (IQR: 13-22). Median ASPECTS score was 9 (IQR: 8-10). The rate of mTICI ≥ 2c after first pass was 53.9% in ITT population (60.0% in per-protocol population) versus 38.5% in the corresponding control population. Functional independence (mRS 0-2) at 90 days was achieved in 61.1% (22/36) in the RapidPulseTM arm and 52.8% (19/36) in the control arm. In the RapidPulseTM arm, no sICH within 24 h and no device-related morbidity or mortality occurred. CONCLUSION Preliminary data suggests RapidPulseTM Aspiration System is highly effective and safe for recanalization of large vessel occlusions.
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Affiliation(s)
| | | | | | - Eren Erdem
- Istanbul Aydin University, Istanbul, Turkey
| | | | | | | | | | | | | | | | | | | | | | | | - Hellen Carm
- Hospital Geral de Fortaleza, Fortaleza, Brazil
| | | | | | | | | | | | | | - Karlis Kupcs
- Paul Stradins Clinical University Hospital, Riga, Latvia
| | | | - Janis Vetra
- Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Gyula Gal
- Odense University Hospital, Odense, Denmark
| | | | - Raul G Nogueira
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Yang HJ. Editors' Pick in January 2024. J Korean Neurosurg Soc 2024; 67:1-2. [PMID: 38151957 PMCID: PMC10788559 DOI: 10.3340/jkns.2023.0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Hee-Jin Yang
- Editor in Chief, Journal of Korean Neurosurgical Society; Department of Neurosurgery, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea
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