Recent Trend for Endovascular Treatment in Patients with Acute Ischemic Stroke: Balloon Guide Catheter

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Neurointervention. 2019;14(2):142-143
Publication date (electronic) : 2019 August 16
doi : https://doi.org/10.5469/neuroint.2019.00136
1Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
Correspondence to: Young-Jun Lee, MD, PhD Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea Tel: +82-2-2290-9153 Fax: +82-2-2293-2111 E-mail: yjleeee@hanyang.ac.kr
Received 2019 June 20; Revised 2019 August 8; Accepted 2019 August 12.

In the era of endovascular treatment for patients with acute ischemic stroke, fast and complete recanalization of the occluded vessel are associated with improved outcomes. To achieve this goal, the balloon guide catheter as well as stentriever or distal access catheter plays an important role. By infilating the balloon, the balloon guide catheter can arrests antegrade flow, which prevents distal migration of clots and enhances aspiration force.

In a recent meta-analysis, patients treated with a balloon guide catheter for mechanical thrombectomy showed higher odds of first-pass recanalization (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.7–2.6) and modified Rankin Scale 0–2 (OR, 1.84; 95% CI, 1.5–2.2) compared to non-balloon guide catheter group [1]. Baek et al. [2] investigated the effect of the balloon guide catheter not only in mechanical thrombectomy but also in aspiration thrombectomy. The balloon guide catheter group demonstrated significantly higher successful recanalization rate (87%) and higher first-pass recanalization rate (37%) compared to those of non-balloon guide catheter group (75% and 14%, respectively; P<0.001 each). In addition, the balloon guide catheter group revealed a significantly fewer number of device passes (2.5) and shorter procedural time (54 minutes) compared to those of non-balloon guide catheter group (3.3 and 68 minutes, respectively; P<0.001 each). Moreover, the use of a balloon guide catheter was an independent factor for successful recanalization (OR, 2.2; 95% CI, 1.5–3.1) and a favorable outcome (OR, 1.4; 95% CI, 1.0–1.9) regardless of the type of first-line endovascular modality used. The European Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) guideline recommends that any mechanical thrombectomy procedure should be preferably conducted together with a proximal balloon guide catheter [3].

In summary, the balloon guide catheter by using mechanical thrombectomy as well as aspiration thrombectomy in endovascular treatment for acute ischemic stroke may be beneficial in terms of recanalization success and functional outcome.

References

1. Brinjikji W, Starke RM, Murad MH, Fiorella D, Pereira VM, Goyal M, et al. Impact of balloon guide catheter on technical and clinical outcomes: a systematic review and meta-analysis. J Neurointerv Surg 2018;10:335–339.
2. Baek JH, Kim BM, Kang DH, Heo JH, Nam HS, Kim YD, et al. Balloon guide catheter is beneficial in endovascular treatment regardless of mechanical recanalization modality. Stroke 2019;50:1490–1496.
3. Turc G, Bhogal P, Fischer U, Khatri P, Lobotesis K, Mazighi M, et al. European Stroke Organisation (ESO)- European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg 2019;11:535–538.

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