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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Topiwala K, Quinn C, Mehta T, Masood K, Grande A, Tummala R, Jagadeesan B. BOBBY balloon guide catheter thrombectomy in large-vessel occlusion stroke: Initial experience. Interv Neuroradiol 2024; 30:80-85. [PMID: 35645160 PMCID: PMC10956468 DOI: 10.1177/15910199221104920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/15/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Nonrandomized studies have found Balloon Guide Catheter (BGC) use to improve technical and functional outcomes in patients undergoing mechanical thrombectomy (MT). MATERIALS AND METHODS We performed a retrospective analysis on prospectively collected data of consecutive ischemic stroke patients undergoing MT at our institution (December 2020-October 2021). Interventions where BOBBY BGC (BBGC, MicroVentionTM, Aliso Viejo, CA) was used were identified. Baseline demographics and clinico-radiographic characteristics were retrospectively collected and analysed using descriptive statistics. RESULTS A total of 43 patients received BBGC-MT (male: female = 26:17, median age 72 years [IQR 62-82]). The most common occlusion site was the middle cerebral artery (MCA) (60.4%). Over half (51.2%) received intravenous thrombolytics. The BBGC tracked well over tortuous aortic arches (type II 34.8%, type III 16.3%), with median arteriotomy-to-perfusion time of 29 min (IQR 20-46). Thromboaspiration was used as first-line MT technique in 69.7% cases, with 1 (IQR 1-2) median MT pass achieving modified TICI (thrombolysis in cerebral ischemia) scores of 3 and 2b/3 in 74.4% and 95.3% respectively. Our overall first pass effect (FPE, defined as mTICI 3 after firs-pass) and modified FPE (defined as, mTICI 2b/3 after first-pass) rates were 51.1% and 79.1% respectively, with rates of 92.3% and 100% respectively when stentretriever and thromboaspiration were combined. The median reduction in National Institutes of Health Stroke Scale (NIHSS) was 9 (IQR 4-15, p < 0.0001), with a median 90-day modified Rankin Score (mRS) of 1.5 (IQR 0-2). CONCLUSIONS BOBBY BGC use resulted in a high first-pass effect rate and may contribute towards improved functional outcomes.
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Affiliation(s)
- Karan Topiwala
- Department of Radiology, Neurosurgery and Neurology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Coridon Quinn
- Department of Radiology, Neurosurgery and Neurology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Tapan Mehta
- Department of Radiology, Neurosurgery and Neurology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Kamran Masood
- Department of Radiology, Neurosurgery and Neurology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Andrew Grande
- Department of Radiology, Neurosurgery and Neurology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Ramachandra Tummala
- Department of Radiology, Neurosurgery and Neurology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Bharathi Jagadeesan
- Department of Radiology, Neurosurgery and Neurology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
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Pero G, Dória HM, Piano M, Macera A, Quilici L, Cervo A. Intracranial Carotid Occlusions : ADAPT versus SAVE and the role of Balloon Guide Catheters. Clin Neuroradiol 2023; 33:825-831. [PMID: 37099134 PMCID: PMC10450001 DOI: 10.1007/s00062-023-01286-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 11/21/2022] [Indexed: 04/27/2023]
Abstract
PURPOSE Specific decisions made by neurointerventionists are often lost behind the data of large-scale trials, and many of these studies have taken place before the development of new techniques and devices. This study compares the stent-retriever assisted vacuum-locked extraction (SAVE) technique with a direct aspiration first pass (ADAPT), as well as the use of a balloon guide catheter (BGC), in intracranial internal carotid artery (IC-ICA) occlusions. METHODS Observational and retrospective study from an Italian hospital, including patients who underwent thrombectomy for IC-ICA occlusion between 1 January 2019 and 31 March 2021. RESULTS Out of 91 IC-ICA occlusions, the ADAPT was the first choice in 20 (22%) and the SAVE in 71 (78%). A BGC was used in 32 (35%) cases, always in conjunction with the SAVE technique. The use of SAVE technique without BGC was associated with the least risk of distal embolization (DE) in the territory occluded (44% vs. 75% when ADAPT technique was used; p = 0.03) and achieved first pass effect (FPE) more frequently (51% vs. 25%, p = 0.09). When the SAVE technique was used, BGC (BGC-SAVE) compared to no BGC (NoBGC-SAVE) was associated with a tendency for less DE (31% vs. 44%, p = 0.3), more FPE (63% vs. 51%, p = 0.5), the same median number of passes (1, p = 0.8) and similar groin-to-recanalization times (36.5 vs. 35.5 min, p = 0.5), none of which reached statistical significance. CONCLUSION Our findings support the use of SAVE technique for IC-ICA occlusions; the added benefit of BGC compared to long sheaths was not remarkable in this sample.
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Affiliation(s)
- Guglielmo Pero
- Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Hugo Mota Dória
- Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
- Department of Neuroradiology, Hospital Central do Funchal, Funchal, Madeira, Portugal
- Universidade da Madeira, Funchal, Madeira, Portugal
| | - Mariangela Piano
- Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Antonio Macera
- Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Luca Quilici
- Department of Neuroradiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Amedeo Cervo
- Department of Neuroradiology, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
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Abdalkader M, Sahoo A, Lee J, Kiley N, Masoud HE, Norbash AM, Nguyen TN. Balloon Gliding Technique: A novel use of balloon guiding catheters in accessing challenging circulations when treating acute ischemic stroke. Interv Neuroradiol 2023; 29:196-200. [PMID: 35286223 PMCID: PMC10152821 DOI: 10.1177/15910199221082473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Challenging arterial anatomy delays, or prevents timely endovascular treatment (EVT) of acute ischemic stroke (AIS). We introduce a new technique called 'Balloon Gliding Technique (BGT)' to overcome difficult arterial anatomy during EVT of AIS, utilizing flow-assistance to access challenging circulations. METHODS Retrospective review of a prospectively collected database of all patients presenting to a single institution with AIS who underwent EVT was performed from January 2021 to June 2021. Patients in whom BGT was performed were assessed. BGT consists of advancing the balloon guide catheter in the cervical carotid artery while its balloon is inflated, and therefore carried by downstream flow. RESULTS Of 51 patients presenting with AIS secondary to large vessel occlusion during the study period, five patients underwent BGT. All five patients had anterior circulation large vessel occlusions. Mean age of the BGT patients was 92.2 years, and all patients were females. A type 3 arch was present in all patients. BGT was performed in all cases following initial failure of conventional techniques to cannulate the target circulation. BGT was successful in achieving distal cervical carotid access in 4 out of the 5 patients in whom BGT was attempted. Successful recanalization (modified treatment in cerebral ischemia 2b-3) was obtained in all cases with no complications. CONCLUSIONS Balloon Gliding Technique (BGT) is a safe technique that can safely overcome challenging anatomy during endovascular treatment of acute ischemic stroke. Further studies can assist in demonstrating both its safety and effectiveness.
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Affiliation(s)
- Mohamad Abdalkader
- Departments of Radiology, Boston
Medical Center, Boston University School of
Medicine, Boston, MA
| | - Anurag Sahoo
- Neurology, Boston Medical Center, Boston University School of
Medicine, Boston, MA
| | - John Lee
- Departments of Radiology, Boston
Medical Center, Boston University School of
Medicine, Boston, MA
| | - Nicole Kiley
- Departments of Radiology, Boston
Medical Center, Boston University School of
Medicine, Boston, MA
| | - Hesham E. Masoud
- Department of Neurology, SUNY Upstate Medical University
Hospital, USA
| | - Alexander M. Norbash
- Department of Radiology, University of California San Diego School
of Medicine, UC San Diego Health, San Diego, CA
| | - Thanh N. Nguyen
- Departments of Radiology, Boston
Medical Center, Boston University School of
Medicine, Boston, MA
- Neurology, Boston Medical Center, Boston University School of
Medicine, Boston, MA
- Neurosurgery, Boston Medical Center, Boston University School of
Medicine, Boston, MA
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5
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Gregory G, Federico C, Lefevre PH, Cyril D, Vincent C, Eker OF. Comparison of mechanical thrombectomy techniques in an in vitro stroke model: How to obtain a first pass recanalization? J Neuroradiol 2022:S0150-9861(22)00176-6. [PMID: 36526015 DOI: 10.1016/j.neurad.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Since mechanical thrombectomy (MT) has proven to be effective in the treatment of acute ischemic stroke (AIS), significant research has been dedicated to establishing procedural techniques offering best rate of first pass effect (FPE). In this study, we compared the efficacy of different techniques in vitro to achieve the first pass recanalisation (FPR). METHODS In vitro MT procedures were performed using a realistic silicone model of the human cerebral vasculature. The MT with stent retriever (SR) were performed with manual co-aspiration through the respective access catheter and intermediate catheter (IC), with Solumbra or partial retrieval techniques into the IC. Two SRs (Solitaire and EmboTrap) were selected to retrieve both red blood cells (RBC) rich and fibrin-rich clots. FPR rates were recorded for each case. RESULTS Overall, 144 MT were performed. FPR rates using the partial retrieval and Solumbra technique were of 100% and 87%, respectively (p = 0.01). The rate of FPR was of 92% using the balloon-guide catheter (BGC) compared to 64% with the guide catheter (GC) (p = 0.0001). With an IC, no differences were found between using a BGC or a GC (87.9% vs 89,6%, p = 0.75). No significant difference was observed between the Embotrap and the Solitaire device for the rate of FPR (82% and 74%, respectively; p = 0.23). CONCLUSIONS In this study, FPR rates were higher with the use of an IC associated with the partial retrieval technique, regardless the guide catheter, the SR, or the clot composition. The less effective technique was the association of GC and SR, without an IC.
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Lee H, Park T, Baek J, Kim S, Lee S, Ryou K. Undeflatable balloon guide catheter (BGC) during endovascular procedure: Rescue strategy. J Cerebrovasc Endovasc Neurosurg 2022; 24:372-379. [PMID: 35794749 PMCID: PMC9829560 DOI: 10.7461/jcen.2022.e2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/27/2021] [Indexed: 01/21/2023] Open
Abstract
The use of a balloon guide catheter (BGC) in the endovascular management of acute ischemic stroke is known to improve the efficacy and efficiency of the procedure by reducing the risk of distal embolization. During the procedure, the balloon of the catheter causes a temporary arrest of cerebral blood flow. However, failure of the balloon to deflate during the BGC procedure can result in catastrophic complications, including aggravated hypoxic damage.<br/> This paper aims to share the resolution and methodological analysis of our experience with BGC balloon deflation failure, which was confirmed by a reproducible experiment under similar conditions.
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Affiliation(s)
- Hyungkyu Lee
- Department of Neurosurgery, Cheju Halla General Hospital, Jeju, Korea
| | - Taejoon Park
- Department of Neurosurgery, Cheju Halla General Hospital, Jeju, Korea,Correspondence to Taejoon Park Department of Neurosurgery, Cheju Halla General Hospital, 65 Doryeong-ro, Jeju-si, Jeju-do 63127, Korea Tel +82-64-740-5000 Fax +82-64-743-3110 E-mail
| | - Jinwook Baek
- Department of Neurosurgery, Cheju Halla General Hospital, Jeju, Korea
| | - Seonghwan Kim
- Department of Neurosurgery, Cheju Halla General Hospital, Jeju, Korea
| | - Sangpyung Lee
- Department of Neurosurgery, Cheju Halla General Hospital, Jeju, Korea
| | - Kyoungsoo Ryou
- Department of Neurosurgery, Cheju Halla General Hospital, Jeju, Korea
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7
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Abstract
Thrombectomy devices played an important role in the success of endovascular treatment trials over the past five years. A balloon guide catheter (BGC) is an adjunctive device used to arrest and reverse flow by inflating the balloon at its tip, which allows for flow reversal in intracranial arteries during retrieval of thrombectomy devices by applying concomitant aspiration through its lumen. Thereby, it can decrease the risk of clot fragmentation and distal embolization. Despite the numerous benchtop and clinical observational studies showing the superiority of BGC to conventional guide catheters in improving reperfusion quality and clinical outcome, its use is still low in clinical practice. The reasons behind this reluctance might be related to technical and cost issues. Therefore, high level evidence data, i.e., a randomized clinical trial, are needed to increase its implementation in thrombectomy procedures. Nonetheless, several obstacles and challenges can prevent the completion of such a trial, and efforts are needed to overcome them. We provide an overview of the current opinions about BGCs in the neurointerventional community and discuss the feasibility and challenges of a possible randomized trial to answer the question "should a BGC be routinely used in endovascular treatment of acute ischemic stroke?"
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Affiliation(s)
- Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
- Department of Diagnostic Imaging, University of Calgary, Calgary, Canada.
| | - Manon Kappelhof
- Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Johanna M Ospel
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
- Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basil, Switzerland
| | - Fouzi Bala
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
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Pederson JM, Reierson NL, Hardy N, Touchette JC, Medam S, Barrett A, Schmidt M, Brinjikji W, Kallmes DF, Kallmes KM. Comparison of Balloon Guide Catheters and Standard Guide Catheters for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. World Neurosurg 2021:S1878-8750(21)01029-9. [PMID: 34280538 DOI: 10.1016/j.wneu.2021.07.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Balloon guide catheters (BGCs) are designed to induce flow arrest during mechanical thrombectomy procedures for acute ischemic stroke due to large-vessel occlusion and have been associated with improved clinical and angiographic outcomes. We conducted a systematic review and meta-analysis evaluating the relative technical and clinical outcomes associated with BGC versus non-BGC approaches. METHODS A systematic review of clinical literature using the PubMed database was undertaken to identify multiarm studies published between 2010 and 2021 reporting the use of BGC versus non-BGC approaches for stroke treatment. Data collected included complete recanalization (thrombolysis in cerebral infarction, TICI), first-pass effect TICI 3, puncture-to recanalization time, number of endovascular attempts, distal embolization, symptomatic intracerebral hemorrhage, 90-day modified Rankin Scale score 0-2, and 90-day mortality. Subgroup analyses assessed the impact of treatment device (stent-retrievers, contact aspiration, combination therapy, and not specified/other). A random effects model was fit for each outcome measure. RESULTS Fifteen studies were included. Compared with non-BGC approaches, patients treated with BGCs had greater odds of TICI 3 (odds ratio [OR] 1.57; 95% confidence interval [95% CI] 1.08-2.29) and first-pass effect TICI 3 (OR 3.63; 95% CI 2.34-5.62), reduced puncture-to-revascularization time (mean difference -7.8; 95% CI -13.3 to -2.2), fewer endovascular attempts (mean difference -0.47; 95% CI -0.68 to -0.26), reduced odds of distal emboli (OR 0.34; 95% CI 0.17-0.71) and symptomatic intracerebral hemorrhage (OR 0.66; 95% CI 0.51-0.86), greater odds of 90-day modified Rankin Scale score 0-2 (OR 1.51; 95% CI 1.27-1.79), and reduced odds of mortality (OR 0.69; 95% CI 0.57-0.82). CONCLUSIONS BGCs yield superior technical and clinical outcomes while reducing patient complications.
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Kim YW, Kang DH, Son W, Hwang YH, Kim YS, Shin JW, Lim JW, Koh HS, Kwon HJ. Usefulness of combination usage of balloon guide catheter with contact aspiration thrombectomy. Acta Neurochir (Wien) 2021; 163:1787-1797. [PMID: 33723972 DOI: 10.1007/s00701-021-04787-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Angiographic outcomes of contact aspiration thrombectomy (CAT), a frontline thrombectomy strategy, can vary depending on balloon guide catheter (BGC) usage, stroke etiology, and occlusion location. The purpose of this study was to analyze conditional outcomes of CAT to determine which result in maximum angiographic benefits. METHODS Patients who received CAT for anterior circulation occlusive stroke between January 2017 and December 2018 were included. Angiographic and clinical outcomes were compared relative to BGC use, stroke etiology, and occlusion location. Multivariable analyses for first-pass reperfusion (FPR) and favorable clinical outcome were performed. RESULTS Of 160 included patients, the rates of FPR, successful reperfusion after CAT, final successful reperfusion, and favorable clinical outcome were 43.1%, 58.1%, 81.9%, and 60.6%, respectively. BGC use was associated with a higher rate of FPR, successful reperfusion after CAT, a lower rate of distal embolization, and faster reperfusion. Based on subgroup analysis, BGC usage in ICA, MCA M1 occlusion, and cardioembolism were associated with higher FPR, successful reperfusion after CAT, and lower distal embolization. Faster reperfusion was achieved in ICA occlusions and cardioembolisms. BGC usage was an independent predictor of FPR. Favorable clinical outcome was associated with male gender, low initial NIHSS score, fast onset to reperfusion, and FPR. CONCLUSIONS In CAT, BGC usage was associated with better angiographic outcomes, including higher FPR, successful reperfusion after CAT, prevention of distal embolization, and faster reperfusion, especially in proximal occlusions and cardioembolisms. These conditions may play a role in maximizing the benefits of CAT.
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Dossani RH, Waqas M, Baig AA, Cappuzzo JM, Popoola D, Rai H, Monteiro A, Levy A, Hashmi E, Davies JM, Levy EI, Siddiqui AH. Walrus Balloon Guide Catheter for Stroke Intervention: Technical Considerations and Clinical Outcomes. World Neurosurg 2021; 152:e144-e148. [PMID: 34033957 DOI: 10.1016/j.wneu.2021.05.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 09/30/2022]
Abstract
BACKGROUND The use of balloon guide catheters (BGCs) for proximal flow arrest during neurointerventional procedures has been limited owing to the incompatibility of BGCs with large-bore aspiration catheters and difficulty in device navigation. The objective of our study was to describe the use of the Walrus catheter (Q'Apel Medical, Fremont, California, USA), a new 8F BGC, with a variety of aspiration catheters and procedures requiring flow arrest. METHODS Consecutive cases using Walrus BGCs for proximal flow arrest during mechanical thrombectomy for acute stroke cases were recorded. The procedure indication, vessel occlusion site, technique, first-pass effect (modified thrombolysis in cerebral infarction score of 2C or 3 after the first recanalization attempt), and complications were recorded and evaluated statistically. RESULTS Our study included 57 patients who had undergone mechanical thrombectomy. In addition to mechanical thrombectomy, the Walrus BGC was used in conjunction with the following techniques: stent retrieval in 2 patients (3.5%), stent retrieval followed by aspiration (Solumbra technique) in 41 (71.9%), and aspiration followed by stent retrieval in 14 patients (24.6%). Eight different aspiration catheters were used in 56 of these 57 procedures. The first-pass effect (modified thrombolysis in cerebral infarction score of 2C and 3) was achieved in 36 (63.2%) of 57 procedures. Two patients (3.5%) had experienced intraoperative complications (symptomatic intracerebral hemorrhage) and one patient (1.8%) had died in-hospital. CONCLUSIONS Our results have demonstrated that the Walrus BGC is a highly navigable 8F guide catheter compatible with most available aspiration catheters. Owing to its compatibility with most available aspiration catheters and ease of use, the Walrus BGC is a valuable addition to the tools available for mechanical thrombectomy.
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Affiliation(s)
- Rimal H Dossani
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Daniel Popoola
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Hamid Rai
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Aaron Levy
- University of California Santa Barbara, Santa Barbara, California, USA
| | | | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, State University of New York at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, State University of New York at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; University of California Santa Barbara, Santa Barbara, California, USA; Jacobs Institute, Buffalo, New York, USA.
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Hafeez MU, Kan P, Srivatsan A, Moore S, Jafari M, DeLaGarza C, Hafeez K, Nascimento FA, Srinivasan VM, Burkhardt JK, Chen S, Johnson J, Saleem Y. Comparison of First-Pass Efficacy Among Four Mechanical Thrombectomy Techniques: A Single-Center Experience. World Neurosurg 2020; 144:e533-e540. [PMID: 32891839 DOI: 10.1016/j.wneu.2020.08.209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/29/2020] [Accepted: 08/29/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND First-pass efficacy (FPE) is an established marker of technical and clinical efficacy among mechanical thrombectomy (MT) techniques. It is unclear what the optimal approach is in achieving FPE. We present a single-center experience comparing rates of FPE among 2 MT techniques and evaluate the potential predictors of FPE among other outcomes. METHODS A single-center retrospective analysis was carried out of patients with consecutive large-vessel occlusion strokes (LVOS) of anterior circulation from September 2015 to April 2019 who underwent MT and for whom data were available on the status of FPE. Four MT techniques were identified: ADAPT (a direct first-pass aspiration), SrADAPT (stent retriever with aspiration), SRBG (stent retriever with balloon guide catheter), and STRAP (stent retriever-aspiration and proximal flow arrest). The primary outcome was FPE and secondary outcomes included the rate of successful reperfusion. RESULTS Among 226 patients with LVOS of the anterior circulation who underwent MT, data were available for 164 on FPE for the 4 MT techniques. SRBG was the most prevalent technique. No significant difference was found in rates of FPE among the 4 MT techniques (P = 0.332). No independent predictors of FPE were identified on multivariable analysis. STRAP had the highest rate of successful reperfusion compared with the other techniques (P = 0.049) and was the only independent predictor of that outcome (P = 0.027). CONCLUSIONS Among patients with LVOS of the anterior circulation, the rate of FPE did not differ among the 4 MT techniques. There were no predictors of FPE among the studied variables. STRAP was the only predictor of successful reperfusion.
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Affiliation(s)
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Aditya Srivatsan
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Shawn Moore
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Mostafa Jafari
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Carlos DeLaGarza
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Komal Hafeez
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Fabio A Nascimento
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | | | - Jan-Karl Burkhardt
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Stephen Chen
- Department of Interventional Neuroradiology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeremiah Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Yasir Saleem
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
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Okada H, Matsuda Y, Malisch A, Chung J, Heiferman DM, Lopes DK. Evaluation of the Intracranial Flow Alteration during Manual Syringe and Continuous Pump Aspiration. J Stroke Cerebrovasc Dis 2019; 28:2574-2579. [PMID: 31239220 DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/14/2019] [Accepted: 05/14/2019] [Indexed: 11/24/2022] Open
Abstract
GOALS While mechanical thrombectomy (MT) has been shown to be effective in the treatment of acute large vessel occlusions, adjunctive measures, such as balloon guide catheters (BGC) and aspiration techniques, are utilized heterogeneously. Clarifying the effects of aspiration applied to the anterior cerebral circulation with proximal flow arrest can shed light on embolic protection during MT. MATERIALS AND METHODS Manual and pump aspiration were applied through a BGC in a synthetic cerebrovascular model with a 60 ml syringe and a Penumbra pump, respectively. Flow direction was observed during the procedure with fluorescent particles and ultraviolet light. Flow rates were monitored at the simulated internal carotid artery and middle cerebral artery (MCA). FINDINGS Both aspiration methods produced retrograde flow in all the modeled cerebrovascular segments. In the syringe aspiration methods, an interval phase occurred during the experimental trial in which suction forces paused and MCA flow became anterograde through posterior communication artery collateral circulation. CONCLUSION Flow patterns vary with different methods of aspiration. With proximal flow arrest, continuous aspiration methods induce constant retrograde flow in all vessels, whereas manual aspiration demonstrates various flow changes, including periods of anterograde flow during the procedure, which may be less effective at distal re-embolization prevention.
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Affiliation(s)
- Hideo Okada
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois; Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama City, Japan.
| | - Yoshikazu Matsuda
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois; Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama City, Japan.
| | - Alex Malisch
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois.
| | - Joonho Chung
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois; Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Daniel M Heiferman
- Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois.
| | - Demetrius K Lopes
- Department of Neurological Surgery, Advocate Health, Park Ridge, Illinois.
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Yi HJ, Sung JH, Lee MH, Lee DH. Experience of the New FlowGate 2 Device as a Balloon Guide Catheter for Ischemic Stroke Intervention. World Neurosurg 2019; 126:e736-42. [PMID: 30851472 DOI: 10.1016/j.wneu.2019.02.140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND We report the experience of the FlowGate2 (FG2) as a new balloon guide catheter in endovascular stroke intervention. METHODS We evaluated the various outcomes and complications of patients with intracranial large artery occlusion undergoing endovascular stroke intervention with FG2 at our center. Baseline characteristics (failure rate of device application, sex, age, risk factors, arterial occlusion sites, and time intervals) were reviewed. Outcomes were evaluated according to National Institutes of Health Stroke Scale score, modified Rankin Scale (mRS) score, number of stent passages required, and Thrombolysis in Cerebral Infarction score. The incidence of hemorrhage, vessel damage, distal emboli, and mortality rate were evaluated as indicators of complications. RESULTS Overall, 70 patients were enrolled, except the 2 patients with application failure of FG2. Seventy patients with a median age of 69 years were treated with FG2. Arterial occlusion involved the M1 (50%) and M2 (14.3%) segments, internal carotid artery (25.7%), and posterior circulation (10%). Median value of mRS at 90 days was 2.8, and 37 patients (52.8%) had a mRS score ≤2. The recanalization rate in patients with a Thrombolysis in Cerebral Infarction score of 2b or 3 was 91.4%. The hemorrhage rate was 5.7%, but none were symptomatic. In terms of complications, distal emboli occurred in 4.3% of cases. CONCLUSIONS Endovascular stroke intervention with the FG2 is safe and effective with good accessibility and less occurrence of distal emboli. Its trackability, stability, and luminal size make the FG2 suitable for stroke intervention.
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Maegerlein C, Berndt MT, Mönch S, Kreiser K, Boeckh-Behrens T, Lehm M, Wunderlich S, Zimmer C, Friedrich B. Further Development of Combined Techniques Using Stent Retrievers, Aspiration Catheters and BGC : The PROTECT PLUS Technique. Clin Neuroradiol 2018; 30:59-65. [PMID: 30413831 DOI: 10.1007/s00062-018-0742-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/25/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE First pass complete (mTICI 3) reperfusion must be regarded as the ultimate goal in mechanical thrombectomy (MT) in patients suffering from an emergent large vessel occlusion (ELVO). With this in mind a technical modification of the previously published PROTECT (PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy) approach, the PROTECTPLUS technique was evaluated. Under proximal flow arrest using a balloon guide catheter (BGC), a stent retriever was only partially inserted into a large-bore aspiration catheter. This construction was subsequently retracted as a unit into the BGC with aspiration both at the aspiration catheter and at the BGC. METHODS A case-control study was performed comparing the PROTECT technique with the PROTECTPLUS technique with respect to the technical and procedural parameters. Patients n = 165 (101 PROTECT, 64 PROTECTPLUS) with ELVO of either the terminus of the internal carotid artery or the proximal middle cerebral artery were included. RESULTS Using the PROTECTPLUS resulted in a higher rate of first pass complete reperfusions (59.4% vs. 27.7%, p < 0.001) as compared with PROTECT. The PROTECTPLUS also led to shorter procedure times (21 min vs. 37 min, p = 0.001) and higher rates of overall complete reperfusion (73.5% vs. 49.5%, p = 0.014) compared to PROTECT. CONCLUSION The PROTECTPLUS technique is a promising technical modification to further optimize endovascular stroke treatment.
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Affiliation(s)
- Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Maria Teresa Berndt
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Mönch
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Kornelia Kreiser
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Tobias Boeckh-Behrens
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Manuel Lehm
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Silke Wunderlich
- Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Teleb MS. Endovascular Acute Ischemic Stroke Treatment with FlowGate Balloon Guide Catheter: A Single-Center Observational Study of FlowGate Balloon Guide Catheter Use. Interv Neurol 2018; 7:327-333. [PMID: 30410509 DOI: 10.1159/000488601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 03/19/2018] [Indexed: 11/19/2022]
Abstract
Background Treatment of large vessel occlusion acute ischemic stroke with mechanical thrombectomy has become the standard of care after recent clinical trials. However, the degree of recanalization with stent retrievers remains very important in overall outcomes. We sought to review the utility of a new balloon guide catheter (BGC) in improving the degree of recanalization in conjunction with mechanical thrombectomy. Methods The medical records of a prospectively collected endovascular ischemic stroke database were reviewed. All consecutive strokes when a FlowGate BGC was used with a thrombectomy stent retriever were identified. Use of a FlowGate BGC, number of passes, final Thrombolysis in Cerebral Infarction (TICI) score, trackability, and use of adjunct devices were all collected and analyzed. Results Use of a FlowGate BGC resulted in 64% (33/52) first-pass effect (FPE) of TICI 2b/3, and specifically 46% (24/52) TICI 3 FPE (true FPE). A total of 52/62 (84%) of thrombectomy cases were treated with BGCs. In the remaining 10, the BGC was not inflated or used due to the clot not being visualized or the lesions being distal and BGC use thus not deemed appropriate. Adjunct use of an aspiration catheter was seen in 12% (6/52) of cases. The overall success with FlowGate BGCs with one or more passes of TICI 2b/3 was 94% (49/52). Trackability was achieved in 92% (57/62) of cases. Conclusions Use of the FlowGate BGC as an adjunct to mechanical thrombectomy was associated with good FPE and an overall recanalization of TICI 2b/3 of 94%.
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Affiliation(s)
- Mohamed S Teleb
- Neurointerventional Surgery, Stroke, and Neurocritical Care, Banner Health, Mesa, Arizona, USA
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