Balloon Guide Catheter in Large-Vessel Occlusion Stroke Therapy

Introduction: Five randomized trials proving the efficacy and safety of mechanical embolectomy for ischemic stroke patients used differing radiological methods to select patients for treatment. Hypothesis: The percentage of patients evaluated in a non-clinical trial setting that would meet radiological criteria to be included in the five trials will differ substantially. Methods: Retrospective study of consecutive ischemic stroke patients who were considered for endovascular stroke therapy based on confirmed intracranial large vessel occlusion (M1, M2, or carotid terminus) at an academic medical center from April 2010 - November 2014. All patients underwent CT perfusion and CT angiogram. Results: The table shows baseline characteristics of 119 patients. Median age was 69 years (IQR 57-79) and median NIHSS 18 (IQR 14-21). Most patients had ASPECTS score ≥ 6 (n=105, 88.2%). The M1 segment of MCA was the most common vessel occluded (n=81, 68%). All 119 patients (100%) met radiological criteria for MR CLEAN while 105 (88.2%) met criteria for SWIFT-PRIME, 96 (80.7%) for REVASCAT, 80/116 (69.0%) for EXTEND IA, and 74 (62.2%) for ESCAPE. IV TPA was given to 58 patients (48.7%) and acute endovascular stroke therapy attempted in 66 (55.5%). Any intracranial hemorrhage was more common in the patients treated with endovascular therapy than in those who were not (36% vs. 17%, p=0.025). The frequency of symptomatic ICH did not significantly differ between these two groups (6.1% vs 3.8%, p=0.691). Conclusions: The percentage of patients with acute stroke and large vessel occlusion that would qualify for endovascular stroke trials based on radiological criteria varies considerably (62%-100%) in a non-clinical trial cohort from an academic comprehensive stroke center. Additional individual patient characteristics influence treatment decisions in non-clinical trial settings.

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Addition of intracranial aspiration to balloon guide catheter does not improve outcomes in large vessel occlusion anterior circulation stent retriever based thrombectomy for acute stroke

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017760 ◽

2021 ◽

pp. neurintsurg-2021-017760

Author(s):

Jordi Blasco ◽

Josep Puig ◽

Antonio López-Rueda ◽

Pepus Daunis-i-Estadella ◽

Laura Llull ◽

...

Keyword(s):

Clinical Outcomes ◽

Scale Score ◽

Outcome Data ◽

Stent Retriever ◽

Large Vessel ◽

Complete Revascularization ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Guide Catheter

BackgroundBalloon guide catheter (BGC) in stent retriever based thrombectomy (BGC+SR) for patients with large vessel occlusion strokes (LVOS) improves outcomes. It is conceivable that the addition of a large bore distal access catheter (DAC) to BGC+SR leads to higher efficacy. We aimed to investigate whether the combined BGC+DAC+SR approach improves angiographic and clinical outcomes compared with BGC+SR alone for thrombectomy in anterior circulation LVOS.MethodsConsecutive patients with anterior circulation LVOS from June 2019 to November 2020 were recruited from the ROSSETTI registry. Demographic, clinical, angiographic, and outcome data were compared between patients treated with BGC+SR alone versus BGC+DAC+SR. The primary outcome was first pass effect (FPE) rate, defined as near complete/complete revascularization (modified Thrombolysis in Cerebral Infarction (mTICI) 2c–3) after single device pass.ResultsWe included 401 patients (BGC+SR alone, 273 (66.6%) patients). Patients treated with BGC+SR alone were older (median age 79 (IQR 68–85) vs 73.5 (65–82) years; p=0.033) and had shorter procedural times (puncture to revascularization 24 (14–46) vs 37 (24.5–63.5) min, p<0.001) than the BGC+DAC+SR group. Both approaches had a similar FPE rate (52% in BGC+SR alone vs 46.9% in BGC+DAC+SR, p=0.337). Although the BGC+SR alone group showed higher rates for final successful reperfusion (mTICI ≥2b (86.8% vs 74.2%, p=0.002) and excellent reperfusion, mTICI ≥2 c (76.2% vs 55.5%, p<0.001)), there were no significant differences in 24 hour National Institutes of Health Stroke Scale score or rates of good functional outcome (modified Rankin Scale score of 0–2) at 3 months across these techniques.ConclusionsOur data showed that addition of distal intracranial aspiration catheters to BGC+SR based thrombectomy in patients with acute anterior circulation LVO did not provide higher rates of FPE or improved clinical outcomes.

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Acute ischaemic stroke interventions: large vessel occlusion and beyond

Stroke and Vascular Neurology ◽

10.1136/svn-2019-000262 ◽

2019 ◽

Vol 5 (1) ◽

pp. 80-85

Author(s):

Ahmad Sweid ◽

Batoul Hammoud ◽

Sunidhi Ramesh ◽

Daniella Wong ◽

Tyler D Alexander ◽

...

Keyword(s):

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Mechanical Thrombectomy ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Stroke Therapy ◽

Comprehensive Overview ◽

Vessel Occlusion ◽

Management Techniques ◽

Randomised Controlled

Care for acute ischaemic stroke is one of the most rapidly evolving fields due to the robust outcomes achieved by mechanical thrombectomy. Large vessel occlusion (LVO) accounts for up to 38% of acute ischaemic stroke and comes with devastating outcomes for patients, families and society in the pre-intervention era. A paradigm shift and a breakthrough brought mechanical thrombectomy back into the spotlight for acute ischaemic stroke; this was because five randomised controlled trials from several countries concluded that mechanical thrombectomy for acute stroke offered overwhelming benefits. This review article will present a comprehensive overview of LVO management, techniques and devices used, and the future of stroke therapy. In addition, we review our institution experience of mechanical thrombectomy for posterior and distal circulation occlusion.

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Walrus large bore guide catheter impact on recanalization first pass effect and outcomes: the WICkED study

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017494 ◽

2021 ◽

pp. neurintsurg-2021-017494

Author(s):

Gustavo M Cortez ◽

Raymond D Turner ◽

Andre Monteiro ◽

Ajit S Puri ◽

Adnan H Siddiqui ◽

...

Keyword(s):

Variable Stiffness ◽

Functional Independence ◽

Large Vessel ◽

Adverse Event Rate ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Stroke Treatment ◽

Guide Catheter ◽

First Pass ◽

Procedural Outcomes

BackgroundThe use of a balloon-guide catheter (BGC) in acute stroke treatment has been widely adopted after demonstrating optimized procedure metrics and outcomes. Initial technical constraints of previous devices included catheter stiffness and smaller inner diameters. We aim to evaluate the performance and safety of the Walrus BGC, a variable stiffness catheter with a large bore 0.087 inch inner diameter (ID), via the the WICkED study (Walrus Large Bore guide Catheter Impact on reCanalization first pass Effect anD outcomes).MethodsThis is a retrospective, site adjudicated, multicenter study on consecutive patients with large vessel occlusion treated with the Walrus BGC. Baseline characteristics, procedural outcomes and functional outcomes were analyzed.ResultsA total of 338 patients met the inclusion criteria. The Walrus was successfully tracked into distal vasculature and allowed therapeutic device delivery in all but 3 cases (0.9%). Large aspiration catheters ≥0.070 inch ID were used in 71.9% of cases. Stent retriever thrombectomy was used as the first-line modality in 59.2% and thromboaspiration in 40.8% of cases. The successful recanalization rate (modified treatment in cerebral ischemia (mTICI) 2b/3) was 94.4%, with 64.8% of the patients achieving mTICI 2b/3 after the first pass. The Walrus-related adverse event rate was 0.6%, corresponding to two vessel dissections. Functional independence was 50% (126/252) and mortality 25% (63/252). Unfavorable outcomes were more likely in older patients, who had unsuccessful reperfusion, longer procedure times, and a higher mean number of passes.ConclusionIn acute ischemic stroke patients presenting with large vessel occlusion, the Walrus BGC demonstrated excellent navigability and safety profile, allowed the accommodation of leading large bore aspiration catheters, and demonstrated high vessel recanalization rates.

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Balloon anchoring technique for thrombectomy in hostile craniocervical arterial anatomy

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-015347 ◽

2020 ◽

Vol 12 (8) ◽

pp. 763-767

Author(s):

Vera Sharashidze ◽

Raul G Nogueira ◽

Alhamza R Al-Bayati ◽

Jonathan A Grossberg ◽

Diogo C Haussen

Keyword(s):

Aortic Arch ◽

Vascular Anatomy ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Guide Catheter ◽

Procedural Time ◽

Type 3 ◽

Arterial Anatomy ◽

Anchoring Technique

BackgroundCraniocervical catheter access in large vessel occlusion acute ischemic strokes can be challenging in cases of unfavorable aortic arch/cervical vascular anatomy, leading to lower recanalization rates, increased procedural time and worse clinical outcomes. We aim to demonstrate the feasibility of the balloon-anchoring technique (BAT) that can be attempted before switching to alternative access sites.MethodsRetrospective review of prospectively collected information on 11 patients in which two variants of the BAT (proximal anchoring: balloon guide catheter (BGC) is inflated to provide support for distal access; distal anchoring: compliant balloon is inflated in an intracranial artery to allow advancement of the support system) were utilized to facilitate craniocervical access due to failure of conventional maneuvers.ResultsTen patients had anterior and one patient had posterior circulation large vessel occlusions. Mean age was 81 years and 81% were females. Type 3 arches were found in 82% and a 9 French balloon guide catheter was used in 82%. Proximal anchoring with BGC was used in four cases while distal anchoring was used in seven patients to allow access to the target vessel, avoiding the need to puncture alternative access sites. Successful reperfusion (modified treatment in cerebral ischemia 2b-3) was achieved in all cases and no complications were observed.ConclusionBAT is safe and feasible. It can be considered as a rescue maneuver in order to avoid switching to a different access during thrombectomy in individuals with unfavorable aortic arch/craniocervical anatomy.

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Noncontrast CT versus Perfusion‐Based Core Estimation in Large Vessel Occlusion: The Blood Pressure after Endovascular Stroke Therapy Study

Journal of Neuroimaging ◽

10.1111/jon.12682 ◽

2020 ◽

Vol 30 (2) ◽

pp. 219-226 ◽

Cited By ~ 1

Author(s):

James E. Siegler ◽

Steven R. Messé ◽

Heidi Sucharew ◽

Scott E. Kasner ◽

Tapan Mehta ◽

...

Keyword(s):

Blood Pressure ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Stroke Therapy ◽

Vessel Occlusion ◽

Noncontrast Ct ◽

Endovascular Stroke Therapy

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Abstract WP40: Balloon Guide Catheter Utilization With Continuous Aspiration Prior to Intracranial Vascular Embolectomy (BGC-CAPTIVE) Associated With Greater Recanalization

Stroke ◽

10.1161/str.51.suppl_1.wp40 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Weiyi Le ◽

Mahesh V Jayaraman ◽

Grayson L Baird ◽

Brian C Mac Grory ◽

Tina M Burton ◽

...

Keyword(s):

Clinical Outcome ◽

Post Treatment ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

First Pass Effect ◽

Guide Catheter ◽

First Pass

Background: Among thrombectomy techniques, Continuous Aspiration Prior to Intracranial Vascular Embolectomy (CAPTIVE) is associated with higher rates of recanalization. Initially, CAPTIVE was performed without a balloon guide catheter (BGC). We aimed to determine the association between BGC usage with final recanalization as well as first pass effect in patients with anterior circulation emergent large vessel occlusion. Methods: We retrospectively reviewed consecutive patients with ICA and M1 occlusions treated with thrombectomy using CAPTIVE over a 45-month period. Post-treatment angiograms were scored by an experienced neurointerventionalist who was blinded to BGC usage and clinical outcome. For both BGC and non-BGC groups, we compared degree of recanalization (using the mTICI 2c scale), first-pass successful recanalization (mTICI 2c/3), and time to recanalization. We examined these results for all patients as well as based on clot location (ICA vs. M1). Results: 357 patients met criteria (median age: 73, median NIHSS: 17) for whom BGC was used in 37/70 (53%) with ICA and 116/287 (40%) with M1 occlusion. Odds of successful reperfusion increased 2.4-fold and odds of complete reperfusion increased 3-fold using BGC (both p<.01). Odds of successful first-pass recanalization (mTICI 2c/3) increased 5-fold for ICA occlusions (p=.004) and 1.7-fold for M1 (p=.03) (See Figure). Recanalization time with BGC for ICA occlusions was faster (22 vs. 36 min, p=.02) but there was no difference in time for M1 occlusions (24 vs. 26 min). Conclusions: BGC usage with the CAPTIVE technique is associated with higher recanalization rates, markedly higher first pass effect (mTICI 2c/3) for both ICA and M1 occlusions, and faster recanalization for ICA occlusions.

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Effect of balloon guide catheter on clinical outcomes and reperfusion in Trevo thrombectomy

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014452 ◽

2019 ◽

Vol 11 (9) ◽

pp. 861-865 ◽

Cited By ~ 8

Author(s):

Thanh N Nguyen ◽

Alicia C Castonguay ◽

Raul G Nogueira ◽

Diogo C Haussen ◽

Joey D English ◽

...

Keyword(s):

Clinical Outcome ◽

Acute Stroke ◽

Stent Retriever ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Stroke Patients ◽

Good Clinical Outcome ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Guide Catheter

IntroductionThe Solitaire stent retriever registry showed improved reperfusion, faster procedure times, and better outcome in acute stroke patients with large vessel occlusion treated with a balloon guide catheter (BGC) and Solitaire stent retriever compared with a conventional guide catheter. The goal of this study was to evaluate whether use of a BGC with the Trevo stent retriever improves outcomes compared with a conventional guide catheter.MethodsThe TRACK registry recruited 23 sites to submit demographic, clinical, and site adjudicated angiographic and outcome data on consecutive patients treated with the Trevo stent retriever. BGC use was at the discretion of the physician.Results536 anterior circulation patients (of whom 279 (52.1%) had BGC placement) were included in this analysis. Baseline characteristics were notable for younger patients in the BGC group (65.4±15.3 vs 68.1±13.6, P=0.03) and lower rate of hypertension (72% vs 79%, P=0.06). Mean time from symptom onset to groin puncture was longer in the BGC group (357 vs 319 min, P=0.06).Thrombolysis in Cerebral Infarction 2b/3 scores were higher in the BGC cohort (84% vs 75.5%, P=0.01). There was no difference in reperfusion time, first pass effect, number of passes, or rescue therapy. Good clinical outcome at 3 months was superior in patients with BGC (57% vs 40%; P=0.0004) with a lower mortality rate (13% vs 23%, P=0.008). Multivariate analysis demonstrated that BGC use was an independent predictor of good clinical outcome (OR 2; 95% CI 1.3 to 3.1, P=0.001).ConclusionsIn acute stroke patients presenting with anterior circulation large vessel occlusion, use of a BGC with the Trevo stent retriever resulted in improved reperfusion, improved clinical outcome, and lower mortality.

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