Balloon guide catheter improvements in thrombectomy outcomes persist despite advances in intracranial aspiration technology.

Autor:	Blasco J; Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain 30018jba@gmail.com., Puig J; IDI-Radiology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Catalunya, Spain., Daunis-I-Estadella P; Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Catalunya, Spain., González E; Interventional Neuroradiology, Radiology, Cruces University Hospital, Barakaldo, País Vasco, Spain., Fondevila Monso JJ; Interventional Neuroradiology, Radiology, Hospital Universitario Cruces, Bilbao, País Vasco, Spain., Manso X; Interventional Neuroradiology, Radiology, Hospital Universitario Cruces, Bilbao, País Vasco, Spain., Oteros R; Diagnostic and Therapeutical Neuroradiology Unit, Reina Sofia University Hospital, Cordoba, Andalucía, Spain., Jimenez-Gomez E; Diagnostic and Therapeutical Neuroradiology Unit, Reina Sofia University Hospital, Cordoba, Andalucía, Spain., Bravo Rey I; Neurorradiologia, Reina Sofia University Hospital, Cordoba, Andalucía, Spain., Vega P; Radiology, HUCA, Oviedo, Asturias, Spain., Murias E; Radiology, HUCA, Oviedo, Asturias, Spain., Jimenez JM; Radiology, HUCA, Oviedo, Asturias, Spain., López-Rueda A; Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain., Renú A; Comprehensive Stroke Unit, Hospital Clinic de Barcelona, Barcelona, Spain., Aixut S; Neuroradiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain., Chirife Chaparro O; Interventional Neuroradiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain., Rosati S; Department of Radiology, Clinical San Carlos Hospital, Hospital Clinico Universitario San Carlos, Madrid, Spain., Moreu M; Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain., Remollo S; Interventional Neuroradiology Unit, University Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain., Aguilar Tejedor Y; Radiology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Canarias, Spain., Terceño M; Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain.; Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain., Mosqueira A; Neuroradiology Department, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain., Nogueira RG; Neurology and Interventional Neuroradiology, Emory University School of Medicine, Atlanta, Georgia, USA., San Roman L; Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2021 Sep; Vol. 13 (9), pp. 773-778. Date of Electronic Publication: 2021 Feb 25.
DOI:	10.1136/neurintsurg-2020-017027
Abstrakt:	Background: First-pass effect (FPE) has been established as a key metric for technical success and strongly correlates with better clinical outcomes. Most data supporting improved outcomes with the use of a balloon guide catheter (BGC) predate the advent of last-generation large-bore intracranial aspiration catheters. We aim to evaluate the impact of BGC in FPE and clinical outcomes in a large cohort of patients treated with contemporary technology. Methods: Patients were recruited from the prospectively ongoing ROSSETTI registry. This registry includes all consecutive patients with anterior circulation large-vessel occlusion (LVO) from 10 comprehensive stroke centers in Spain. Demographic, clinical, angiographic, and clinical outcome data were compared between BGC and non-BGC groups. FPE was defined as the achievement of mTICI2c-3 after a single device pass. Results: 426 patients were included out of which 271 (63.62%) used BCG. BGC-treated patients had higher FPE rate (45.8% vs 27.7%; P<0.001), higher final mTICI ≥2 c recanalization rate (76.8% vs 50.3%, respectively; P<0.001), shorter procedural time [median (IQR), 30 (19-58) vs 43 (33-71) min; P<0.001], higher NIHSS difference from admission to 24 hours [median (IQR), 8 (2-12) vs 3 (0-10); P=0.001], and lower mortality rate (17.6% vs 29.8%, P=0.026) compared with non-BGC patients. BGC use was an independent predictor of FPE (OR 2.197, 95% CI 1.436 to 3.361; P<0.001), and excellent clinical outcome at 3 months (OR 0.34, 95% CI 0.17 to 0.68; P=0.002). Conclusions: Our results support the benefit of BGC use on angiographic and clinical outcomes in anterior circulation LVO ischemic stroke remain significant even when considering recent improvements in intracranial aspiration technology. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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