J Korean Neurosurg Soc.  2017 Feb;60(2):155-164. 10.3340/jkns.2016.0809.003.

Efficacy of Balloon-Guiding Catheter for Mechanical Thrombectomy in Patients with Anterior Circulation Ischemic Stroke

• Oh JS
• Yoon SM
• Shim JJ
• Doh JW
• Bae HG
• Lee KS

• KMID: 2374876
• DOI: http://doi.org/10.3340/jkns.2016.0809.003

Abstract

OBJECTIVE
To evaluate the efficacy of balloon guiding catheter (BGC) during thrombectomy in anterior circulation ischemic stroke.
METHODS
Sixty-two patients with acute anterior circulation ischemic stroke were treated with thrombectomy using a Solitaire stent from 2011 to 2016. Patients were divided into the BGC group (n=24, 39%) and the non-BGC group (n=38, 61%). The number of retrievals, procedure time, thrombolysis in cerebral infarction (TICI) grade, presence of distal emboli, and clinical outcomes at 3 months were evaluated.
RESULTS
Successful recanalization was more frequent in BGC than in non-BGC (83% vs. 66%, p=0.13). Distal emboli occurred less in BGC than in non-BGC (23.1% vs. 57.1%, p=0.02). Good clinical outcome was more frequent in BGC than in non-BGC (50% vs. 16%, p=0.03). The multivariate analysis showed that use of BGC was the only independent predictor of good clinical outcome (odds ratio, 5.19: 95% confidence interval, 1.07-25.11). More patients in BGC were successfully recanalized in internal carotid artery (ICA) occlusion with small retrieval numbers (<3) than those in non-BGC (70% vs. 24%, p=0.005). In successfully recanalized ICA occlusion, distal emboli did not occur in BGC, whereas nine patients had distal emboli in non-BGC (0% vs. 75%, p=0.001) and good clinical outcome was superior in BGC than in non-BGC (55.6% vs. 8.3%, p=0.01).
CONCLUSION
A BGC significantly reduces the number of retrievals and the occurrence of distal emboli, thereby resulting in better clinical outcomes in patients with anterior circulation ischemic stroke, particularly with ICA occlusion.

Keyword

Balloon guiding catheter; Anterior circulation; Ischemic stroke; Thrombectomy; ICA occlusion

MeSH Terms

Carotid Artery, Internal
Catheters*
Cerebral Infarction
Humans
Multivariate Analysis
Stents
Stroke*
Thrombectomy*

Reference

References

1. Chueh JY, Kuhn AL, Puri AS, Wilson SD, Wakhloo AK, Gounis MJ. Reduction in distal emboli with proximal flow control during mechanical thrombectomy: a quantitative in vitro study. Stroke. 44:1396–1401. 2013.

2. Chueh JY, Puri AS, Wakhloo AK, Gounis MJ. Risk of distal embolization with stent retriever thrombectomy and ADAPT. J Neurointerv Surg. 8:197–202. 2016.

3. Costalat V, Lobotesis K, Machi P, Mourand I, Maldonado I, Heroum C, et al. Prognostic factors related to clinical outcome following thrombectomy in ischemic stroke (RECOST study). 50 patients prospective study. Eur J Radiol. 81:4075–4082. 2012.

4. Davalos A, Pereira VM, Chapot R, Bonafe A, Andersson T, Gralla J, et al. Retrospective multicenter study of Solitaire FR for revascularization in the treatment of acute ischemic stroke. Stroke. 43:2699–2705. 2012.

5. Demerath T, Reinhard M, Elsheikh S, Keuler A, Urbach H, Meckel S. Balloon guide catheter in complex anterior circulation mechanical thrombectomy: beyond proximal occlusion and flow reversal. Clin Neuroradiol. 26:369–373. 2016.

6. Eesa M, Almekhlafi MA, Mitha AP, Wong JH, Goyal M. Manual aspiration thrombectomy through balloon-tipped guide catheter for rapid clot burden reduction in endovascular therapy for ICA L/T occlusion. Neuroradiology. 54:1261–1265. 2012.

7. Ergun O, Gunes Tatar I, Birgi E, Hekimoglu B. Evaluation of vertebral artery dominance, hypoplasia and variations in the origin: angiographic study in 254 patients. Folia Morphol (Warsz). 75:33–37. 2016.

8. Klinger-Gratz PP, Schroth G, Gralla J, Jung S, Weisstanner C, Verma RK, et al. Protected stent retriever thrombectomy prevents iatrogenic emboli in new vascular territories. Neuroradiology. 57:1045–1054. 2015.

9. Kurre W, Vorlaender K, Aguilar-Perez M, Schmid E, Bazner H, Henkes H. Frequency and relevance of anterior cerebral artery embolism caused by mechanical thrombectomy of middle cerebral artery occlusion. AJNR Am J Neuroradiol. 34:1606–1611. 2013.

10. Nguyen TN, Malisch T, Castonguay AC, Gupta R, Sun CH, Martin CO, et al. Balloon guide catheter improves revascularization and clinical outcomes with the Solitaire device: analysis of the North American Solitaire Acute Stroke Registry. Stroke. 45:141–145. 2014.

11. Pereira VM, Gralla J, Davalos A, Bonafe A, Castano C, Chapot R, et al. Prospective, multicenter, single-arm study of mechanical thrombectomy using solitaire flow restoration in acute ischemic stroke. Stroke. 44:2802–2807. 2013.

12. Saver JL, Jahan R, Levy EI, Jovin TG, Baxter B, Nogueira RG, et al. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet. 380:1241–1249. 2012.

13. Tomsick T, Broderick J, Carrozella J, Khatri P, Hill M, Palesch Y, et al. Revascularization results in the Interventional Management of Stroke II trial. AJNR Am J Neuroradiol. 29:582–587. 2008.