Abstract WP198: Balloon Guide Catheter Impact on Angiographic and Clinical Outcomes in Distal Medium Vessel Occlusion Strokes Undergoing Thrombectomy

Abstract

Background: The use of balloon guide catheter (BGC) has been associated with better reperfusion and clinical outcomes in mechanical thrombectomy (MT) for large vessel occlusion strokes (LVOS). The association between BGC and angiographic and clinical outcomes in patients with distal medium vessel occlusion strokes (DMVO) undergoing MT has not been investigated. Methods: This is a retrospective analysis of a prospectively collected database from 14 comprehensive stroke centers in the United States and Europe. Patients were included if they had anterior circulation DMVO due to MCA-M3/M4 or ACA-A1/A2-3 and were treated with MT using stentriever, contact aspiration, or a combination of both techniques as first-line therapy. The cohort was divided into two groups: 1) BGC and 2) non-BGC. Uni and multivariable analyses were used to identify predictors of first pass effect (FPE) defined as eTICI grade 2C or 3 after single device pass, as well as mRS0-1, mRS0-2, and mortality at 90 days. Results: A total of 199 patients were eligible for analysis. The BGC group (n=73) had comparable baseline characteristics as compared to the non-BGC group (n=126), except for lower median age and frequency of hyperlipidemia, atrial fibrillation, and White patients, and higher frequency of tandems. Procedurally, the BGC group had a less frequent use of contact aspiration (23.3% vs. 53.2%), and higher proportions of stent-retriever use (35.6% vs. 13.5%) and combined technique (41.1% vs. 33.3%; P<0.001) as first-line therapy. A lower number of passes (1 vs. 2, P<0.001), shorter procedure time (40 vs. 46 minutes, P=0.029), and higher FPE rates (53% vs 13%; P<0.001) were observed in the BGC group. On multivariable analysis, the BGC group showed higher rates of FPE (53.4% vs. 13.7%, aOR 6.74, 95%CI [3.08-14.75], P<0.001), 90-day mRS 0-1 (42.9% vs. 27.1%, aOR 2.28, 95%CI [1.06-4.91], P=0.035), and 90-day mRS 0-2 (60.3% vs. 41.5%, aOR 2.47, 95%CI [1.15-5.31], P=0.02). The rates of successful reperfusion at the end of the procedure, sICH, and 90-day mortality were comparable between both groups. Conclusions: The present study suggests that the use of BGC in DMVO undergoing MT is associated with improved angiographic and clinical outcomes with no safety concerns. Prospective studies are warranted.