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      Comparison of Clinical and Radiological Outcomes Between Different (Balloon) Guide Catheter With and Without Inflated Balloon in Acute Ischemic Stroke Patients: A MaSQ-Registry Study

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          Abstract

          Purpose

          Balloon guide catheters (BGCs) are used in endovascular treatment (EVT) for ischemic stroke. Previous literature did not distinguish between BGC use with and without inflated balloon. This study aims to compare outcomes between non-BCG and BGC use with and without inflated balloon during EVT.

          Methods

          Patients who underwent EVT for anterior circulation ischemic stroke between September 2020 and February 2023 were analyzed. Patients were divided into three groups: non-BGC, BGC with inflated balloon, or BGC without inflated balloon. The primary outcome was the ordinal modified Rankin Scale (mRS) at 90-day follow-up. Secondary outcomes included expanded Thrombolysis In Cerebral Ischemia score (eTICI) and periprocedural complications. Regression analyses with BGC with inflated balloon as comparator were performed with adjustments. Subgroup analyses were conducted based on first-line thrombectomy technique.

          Results

          Out of 511 patients, 428 patients were included. Compared to BCG with inflated balloon, the mRS at 90 days did not differ in the group without inflated balloon (adjusted common [ac]OR: 1.07, 95%CI 0.67–1.73) or non-BGC (acOR: 1.42, 95%CI 0.83–2.42). Compared to patients treated with a BGC with inflated balloon, those treated with BGC without inflated balloon had lower eTICI scores (acOR: 0.59, 95%CI 0.37–0.94), and patients treated with non-BGC had lower chances of periprocedural complications (aOR: 0.41, 95%CI 0.20–0.86).

          Conclusions

          This study shows no clinical differences in ischemic stroke patients treated with BGC with inflated balloon compared to non-BGC and BGC without inflated balloon, despite lower periprocedural complication rates in the non-BGC group and lower eTICI scores in the BGC without inflated balloon group.

          Level of Evidence

          Level 3, non-controlled retrospective cohort study.

          Graphical Abstract

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00270-024-03718-9.

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          Most cited references22

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          National Institutes of Health Stroke Scale (NIHSS).

          Joanna Diong, Li Kwah (2014)
          Article 0 comments Cited 189 times – based on 0 reviews     Review now
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            CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct.

            I.Y.L. Tan, A.M. Demchuk, J Hopyan … (2009)
            Clot extent, location, and collateral integrity are important determinants of outcome in acute stroke. We hypothesized that a novel clot burden score (CBS) and collateral score (CS) are important determinants of clinical and radiologic outcomes and serve as useful additional stroke outcome predictors. One hundred twenty-one patients with anterior circulation infarct presenting within 3 hours of stroke onset were reviewed. The Spearman correlation was performed to assess the correlation between CBS and CS and clinical and radiologic outcome measures. Patients were dichotomized by using a 90-day modified Rankin scale (mRS) score. Uni- and multivariate logistic regression models were used to assess variables predicting favorable clinical and radiologic outcomes. Receiver operating characteristic and intraclass correlation coefficient (ICC) analyses were performed. Diagnostic performance of a CBS threshold of >6 was assessed. There were 85 patients (mean age, 70 +/- 14.5 years). Patients with higher CBS and CS demonstrated smaller pretreatment perfusion defects and final infarct volume and better clinical outcome (all, P 6 predicted good clinical outcome with an area under the curve of 0.75 (95% confidence interval [CI], 0.65-0.84; P = .0001), sensitivity of 73.0 (95% CI, 55.9-86.2), and specificity of 64.6 (95% CI, 49.5-77.8). The recanalization rate with intravenous recombinant tissue plasminogen activator was higher in patients with CBS >6 (P = .04; odds ratio, 3.2; 95% CI, 1.1-9.4). The ICC was 0.97 (95% CI, 0.95-0.98) and 0.87 (95% CI, 0.80-0.91) for CBS and CS, respectively. CBS and CS are useful additional markers predicting clinical and radiologic outcomes.
            Article 0 comments Cited 127 times – based on 0 reviews     Review now
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              eTICI reperfusion: defining success in endovascular stroke therapy

              David Liebeskind, Serge Bracard, Francis Guillemin … (2018)
              Revascularization after endovascular therapy for acute ischemic stroke is measured by the Thrombolysis In Cerebral Infarction (TICI) scale, yet variability exists in scale definitions. We examined the degree of reperfusion with the expanded TICI (eTICI) scale and association with outcomes in the HERMES collaboration of recent endovascular trials.
              Article 0 comments Cited 114 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                R. R. M. M. Knapen:
                ORCID: http://orcid.org/0000-0003-4677-3685
                robrecht.knapen@mumc.nl
                Journal
                Journal ID (nlm-ta): Cardiovasc Intervent Radiol
                Journal ID (iso-abbrev): Cardiovasc Intervent Radiol
                Title: Cardiovascular and Interventional Radiology
                Publisher: Springer US (New York )
                ISSN (Print): 0174-1551
                ISSN (Electronic): 1432-086X
                Publication date (Electronic): 19 April 2024
                Publication date PMC-release: 19 April 2024
                Publication date (Print): 2024
                Volume: 47
                Issue: 7
                Pages: 918-928
                Affiliations
                [1 ]GRID grid.5012.6, ISNI 0000 0001 0481 6099, Department of Radiology and Nuclear Medicine, , Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), Maastricht University, ; Maastricht, The Netherlands
                [2 ]Department of Neurology, Zuyderland MC, Heerlen, Sittard-Geleen, The Netherlands
                [3 ]Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, ( https://ror.org/02jz4aj89) Maastricht, The Netherlands
                [4 ]GRID grid.412966.e, ISNI 0000 0004 0480 1382, Department of Neurology, , Maastricht University Medical Center+ and School for Cardiovascular Diseases (CARIM), ; Maastricht, The Netherlands
                [5 ]Present Address: School for Cardiovascular Diseases Maastricht (CARIM), Maastricht University, ( https://ror.org/02jz4aj89) Maastricht, The Netherlands
                Author information
                http://orcid.org/0000-0003-4677-3685
                Article
                Publisher ID: 3718
                DOI: 10.1007/s00270-024-03718-9
                PMC ID: 11239717
                PubMed ID: 38639780
                SO-VID: b77ecc49-e5a5-442b-b1da-5d7df71d62ec
                Copyright © © The Author(s) 2024, corrected publication 2024
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 7 December 2023
                Date accepted : 23 March 2024
                Categories
                Subject: Clinical Investigation
                Custom metadata
                issue-copyright-statement © Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2024

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: balloon guide catheter (bgc),acute ischemic stroke (ais),endovascular treatment (evt),stroke
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: balloon guide catheter (bgc), acute ischemic stroke (ais), endovascular treatment (evt), stroke

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