Use Of Balloon Guide Catheter Research Articles

Combined Aspiration and Stent Retriever Thrombectomy for Distal Carotid Artery Occlusion Using Balloon Guide versus Non-Balloon Guide Catheter.

Background: The introduction of endovascular thrombectomy dramatically changed acute stroke management and became the standard treatment. Balloon guide catheters provide flow arrest during the clot retrieval process and have several advantages.This study aimed to compare balloon guide catheters (BGCs) versus non-balloon guide catheters (NBGCs) as a part of a combined treatment modality in patients presenting with acute ischemic stroke. Methods: This retrospective study included n = 65 patients who underwent a combined endovascular stroke treatment for distal internal carotid artery (ICA) occlusion. Patients underwent aspiration and stent retriever thrombectomy with the use of BGCs (Group 1, n = 27) or NBGCs (Group 2, n = 38). Results: The groups were compared for outcomes: the National Institutes of Health Stroke Scale (NIHSSS) score change, successful recanalization, good functional outcome at three months, and in-hospital mortality. Conclusion: The two groups didn't differ in terms of the NIHSS score change compared to baseline (p > 0.05). Moreover, there were no significant differences between the two groups in terms of the successful recanalization rate, three-month favorable functional outcome rate, and in-hospital mortality (p = 0.292, p = 0.952, p = 0.178), respectively. Further prospective studies with a larger number of patients and better methodology are warranted.

Flow reversal during stroke thrombectomy.

When performing mechanical thrombectomy for stroke patients, some physicians use balloon guide catheters (BGCs) in order to achieve flow reversal and thereby improve reperfusion quality. There is substantial evidence favoring the use of BGCs to improve reperfusion rates and clinical outcomes for thrombectomy patients; however, as we will outline in this review, there is also evidence that BGCs do not achieve reliable flow reversal in many circumstances. Therefore, if we are able to modify our techniques to improve the likelihood of flow reversal during thrombectomy maneuvers, we may be able to further improve reperfusion quality and clinical outcomes. This paper provides an overview of concepts on this topic and outlines some potential techniques to facilitate flow reversal more consistently, including a method to visually confirm it, with the aim of making iterative improvements towards optimal reperfusion for stroke patients.

Predictors of Emboli in Mechanical Thrombectomy for Anterior Circulation Stroke.

Emboli commonly occurs in mechanical thrombectomy (MT). The objective of this study was to analyze predicting factors of emboli after MT. Patients who underwent MT with successful reperfusion for anterior circulation occlusion were enrolled. Emboli included distal emboli at digital subtraction angiography (DSA) and unexpected embolic infarct on diffusion-weighted image (DWI) without distal emboli at DSA. Baseline characteristics, procedural details, angiographic outcomes, and clinical outcomes were reviewed. Multivariable analyses were performed to evaluate predictive factors for the occurrence of emboli. Of 601 patients, 149 (24.8%) patients had distal emboli at DSA, and 169 (28.1%) patients had unexpected embolic infarction on DWI even without distal emboli at DSA. A total of 318 (52.9%) patients were enrolled in the embolic group, and 283 (47.1%) patients were assigned to the non-embolic group. In multivariate analysis, larger microcatheter (OR 1.26, 95% CI 1.12-1.94; p = 0.047), clot passage (OR 1.33, 95% CI 1.07-1.87; p = 0.041), use of balloon guide catheter (BGC) (OR 0.70, 95% CI 0.52-0.92; p = 0.014), early ballooning of BGC (OR 0.68, 95% CI 0.50-0.90; p = 0.009), and longer stent retriever (OR 0.72, 95% CI 0.54-0.90; p = 0.029) were associated with occurrence of emboli. MT with only a stent retriever, use of a larger microcatheter, and clot passage might increase the risk of emboli. In contrast, contact aspiration thrombectomy, use of BGC, early ballooning of BGC, and use of longer stent retrievers could reduce the chance of emboli.

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

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.

Abstract TP187: Comparison of Balloon Guide Catheter versus Non-Balloon Guide Catheter for Mechanical Thrombectomy in Distal Medium Vessel Occlusion

Introduction: While balloon guide catheters (BGCs) enhance safety and efficacy of mechanical thrombectomy in large vessel occlusions, their impact on distal medium vessel occlusion (DMVO) remains underexplored. This study aimed to compare the outcomes of BGC vs non-BGC in DMVO thrombectomy. Methods: This retrospective study focused on DMVO cases defined as occlusions in M2-M4 middle cerebral artery, anterior cerebral artery, and posterior cerebral artery. Baseline characteristics and technical and clinical outcomes were compared between the two groups, with subgroup analysis in first-line thrombectomy techniques, including ADAPT, stent retriever, and Solumbra. First pass effect (FPE) was defined as a modified Thrombolysis in Cerebral Infarction (mTICI) score ≥ 2C after the first pass. Results: A total of 1,508 patients were included, of whom 231 (15.3%) were in the BGC group and 1,277 (84.7%) were in the Non-BGC group. The BGC group was associated with a lower mTICI score ≥ 2C (overall: 43.2% vs. 52.7%, p = 0.01; ADAPT: 42.2% vs. 57.1%, p = 0.01; Solumbra: 32.4% vs. 51.4%, p = 0.005), longer puncture to intracranial access time (overall: 15 vs. 8 min, p < 0.001; ADAPT: 17 vs. 8 min, p < 0.001; Solumbra: 12 vs. 8 min, p = 0.02), and longer puncture to recanalization time (overall: 97 vs. 35 min, p < 0.001; ADAPT: 100 vs. 28 min, p < 0.001; Solumbra: 78 vs. 46 min, p < 0.001; Stent retriever: 95 vs. 45 min, p < 0.001 ). The BGC group also had a lower FPE rate (17.4% vs. 30.7%, p = 0.03) in the Solumbra subgroup. In terms of clinical outcomes, the BGC group had a lower rate of distal embolization (overall: 8.8% vs. 14.9%, p = 0.02), but there were no significant differences in other clinical outcomes between the two groups in first-line thrombectomy techniques. Conclusions: Our findings showed that the use of BGC in DMVO had a lower mTICI score, reduced FPE rates, decreased distal embolization, and longer procedure times. Figure 1: Figure 2:

Comparison of balloon guide catheter versus non-balloon guide catheter for mechanical thrombectomy in patients with distal medium vessel occlusion

BackgroundSeveral studies have established the safety and efficacy of balloon guide catheters (BGCs) for large vessel occlusions. However, the utility of BGCs remains largely unexplored for distal medium vessel occlusions...

Impact of Balloon Guide Catheters in Elderly Patients Treated with Mechanical Thrombectomy: Insights from the ROSSETTI Registry.

Several nonrandomized studies have demonstrated the effectiveness of balloon guide catheters in treating patients with anterior circulation large-vessel occlusion. However, their impact on the elderly populations has been underreported. We aimed to analyze the effect of balloon guide catheters in a cohort of elderly patients (80 years of age or older) with anterior circulation large-vessel occlusion. Consecutive patients from June 2019 to June 2022 were collected from the ROSSETTI Registry. Demographic and clinical data, angiographic endovascular technique, and clinical outcome were compared between balloon guide catheter and non-balloon guide catheter groups. We studied the association between balloon guide catheters and the rate of complete recanalization after a single first-pass effect modified TICI 2c-3, as well as their association with functional independence at 3 months. A total of 808 patients were included during this period, 465 (57.5%) of whom were treated with balloon guide catheters. Patients treated with balloon guide catheters were older, had more neurologic severity at admission and lower baseline ASPECTS, and were less likely to receive IV fibrinolytics. No differences were observed in terms of the modified first-pass effect between groups (45.8 versus 39.9%, P = .096). In the multivariable regression analysis, balloon guide catheter use was not independently associated with a modified first-pass effect or the final modified TICI 2c-3, or with functional independence at 3 months. In our study, balloon guide catheter use during endovascular treatment of anterior circulation large-vessel occlusion in elderly patients did not predict the first-pass effect, near-complete final recanalization, or functional independence at 3 months. Further studies, including randomized clinical trials, are needed to confirm these results.

558 Use Of Balloon-Guide Catheters For Concomitant Mechanical Thrombectomy And Carotid Revascularization With Flow-Arrest Results In Significantly Lower sICH And Better 90-Day Outcomes In Tandem Stroke Patients: A Propensity Score-Matched Study

INTRODUCTION: A larger than normal clot burden accounts for worse presentation and poorer thrombectomy outcomes in tandem stroke cases. METHODS: A prospectively maintained database was retrospectively searched for patients who presented with a tandem stroke. Patients were dichotomized into two groups; those treated with BGCs and those treated without BGCs. A one-to-one matched propensity score analysis was performed to adjust for treatment selection bias using the nearest-neighbor matching technique for covariates (baseline comorbidities and stroke severity). Patient demographics, presentation characteristics, and procedural details were recorded. Outcomes were assessed as periprocedural sICH, in-hospital mortality, and 90-day mRS. Mann-whitney U test, and multivariate logistic regression was performed to compare the procedural parameters and the clinical outcomes between groups. RESULTS: We included 125 patients (BGC: 85 [40 after PSM]; No BGC: 40 [40 after PSM]). Concomitant carotid revascularization (stenting or angioplasty) was performed in all cases. After PSM, no difference was seen between the two groups in terms of comorbidities, and initial stroke severity. BGC group had significantly lower procedure duration (61.5% vs. 77.9% (OR = 0.996; P = 0.006)), lower NIHSS at discharge (8.0% vs. 11.0% (OR = 0.987; P = 0.042)), and higher odds of good outcomes (mRS 0-2 at 90-day) (52.3% vs. 27.5% (OR = 0.34; P = 0.040)). On multivariate regression analysis, BGC group had significantly higher rate of first-pass effect (mTICI 2B-3) (OR = 0.660, 95% CI = 0.480-0.908;P = 0.013), and a lower periprocedural sICH rate (OR = 0.615, 95% CI = 0.406-0.932; P = 0.025). No difference in in-hospital mortality was observed (OR = 1.591; 95% CI = 0.976-2.593; P = 0.067). CONCLUSIONS: Use of BGCs for concomitant mechanical thrombectomy and carotid revascularization with flow-arrest is safe and results in superior clinical and angiographic outcomes in tandem stroke patients.

Distal Embolization in Relation to Radiological Thrombus Characteristics, Treatment Details, and Functional Outcome.

Distal embolization (DE) is a common complication of endovascular treatment (EVT). We investigated the association of radiological thrombus characteristics and treatment details with DE. Patients with thin-slice (≤2.5 mm) baseline noncontrast computed tomography and computed tomography angiography from the ESCAPE-NA1 trial (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischemic Stroke) were included. Thrombus annotation was performed manually on coregistered scans by experienced readers. We assessed thrombus location, distance from internal carotid artery terminus, length, perviousness, absolute attenuation, and hyperdense artery sign. In addition, we evaluated balloon guide catheter use during EVT, first-line EVT approach, the number of thrombectomy passes, and prior intravenous thrombolysis administration. DE was defined as the occurrence of emboli distal to the target artery or in new territories during EVT. The association between thrombus characteristics, treatment details, and DE was evaluated using descriptive statistics and multivariable mixed-effects logistic regression, resulting in adjusted odds ratios (aOR) with 95% CI. Interaction between IVT and radiological thrombus characteristics was assessed by adding interaction terms in separate models. In total, 496 out of 1105 (44.9%) ESCAPE-NA1 patients were included. DE was detected in 251 out of 496 patients (50.6%). Patients with DE had longer thrombi (median, 28.5 [interquartile range, 20.8-42.3] mm versus 24.4 [interquartile range, 17.1-32.4] mm; P<0.01). There were no statistically significant differences in the other thrombus characteristics. Factors associated with DE were thrombus length (aOR, 1.02 [95% CI, 1.01-1.04]), balloon guide catheter use (aOR, 0.49 [95% CI, 0.29-0.85]), and number of passes (aOR, 1.24 [95% CI, 1.04-1.47]). In patients with hyperdense artery sign, IVT was associated with reduced odds of DE (aOR, 0.55 [95% CI, 0.31-0.97]), P for interaction=0.04. DE was associated with longer thrombi, no balloon guide catheter use, and more EVT passes. IVT was associated with a reduced risk of DE in patients with hyperdense artery sign. These findings may support treatment decisions on IVT and EVT approaches.

EE127 Economic Impact of Balloon Guide Catheter Use with Mechanical Thrombectomy for Acute Ischemic Stroke: A U.S. Payer Perspective Cost Analysis

Balloon guide catheters (BGCs) can be used adjunctively during mechanical thrombectomy (MT) procedures to arrest blood flow and improve reperfusion in the treatment of Acute Ischemic Stroke (AIS). Two recent meta-analyses reported significantly higher rates of 90-day good functional outcomes (modified Rankin Score (mRS) 0-2), in procedures utilizing MT+BGC vs. MT alone. This analysis aims to evaluate the potential economic impact of achieving improved functional outcomes associated with adjunctive BGC use.

Safety of Sheathless Transradial Balloon Guide Catheter Placement for Acute Stroke Thrombectomy

Transradial access has been described for mechanical thrombectomy in acute stroke, and proximal balloon occlusion has been shown to improve recanalization and outcomes. However, sheathed access requires a larger total catheter diameter at the access site. We aimed to characterize the safety of sheathless transradial balloon guide catheter use in acute stroke intervention. Consecutive patients who underwent sheathless right-sided transradial access for thrombectomy with a balloon guide catheter were identified in a prospectively collected dataset from 2019 to 2021. Demographics, procedure details, and short-term outcomes were collected and reported with descriptive statistics. A total of 48 patients (20 women) with a mean age of 72.3 years were identified. Of patients, 56.3% had occlusions in the left-sided circulation; 35 (72.9%) had M1 occlusions, 7 (14.6%) had M2 occlusions, and 6 (12.5%) had internal carotid artery occlusions. Tissue plasminogen activator was administered to 16 (33.3%) patients. Five (10.4%) patients underwent intraprocedural carotid stenting. The cohort had successful reperfusion after a median of 1 (interquartile range: 1, 2) pass. Median time from access to recanalization was 31 (interquartile range: 25, 53) minutes. A postprocedural Thrombolysis In Cerebral Infarction score of ≥2b was achieved in 46 (95.8%) patients. Five patients had wrist access site hematomas. All hematomas resolved with warm compresses, and no further intervention was required. Sheathless radial access using a balloon guide catheter may be safely performed for acute ischemic stroke with excellent radiographic outcomes. Further investigation is warranted to evaluate the comparative effectiveness of sheathless compared with sheathed transradial balloon guide access.

BOBBY balloon guide catheter thrombectomy in large-vessel occlusion stroke: Initial experience.

Nonrandomized studies have found Balloon Guide Catheter (BGC) use to improve technical and functional outcomes in patients undergoing mechanical thrombectomy (MT). We performed a retrospective analysis on prospectively collected data of consecutive ischemic stroke patients undergoing MT at our institution (December 2020-October 2021). Interventions where BOBBY BGC (BBGC, MicroVentionTM, Aliso Viejo, CA) was used were identified. Baseline demographics and clinico-radiographic characteristics were retrospectively collected and analysed using descriptive statistics. A total of 43 patients received BBGC-MT (male: female = 26:17, median age 72 years [IQR 62-82]). The most common occlusion site was the middle cerebral artery (MCA) (60.4%). Over half (51.2%) received intravenous thrombolytics. The BBGC tracked well over tortuous aortic arches (type II 34.8%, type III 16.3%), with median arteriotomy-to-perfusion time of 29 min (IQR 20-46). Thromboaspiration was used as first-line MT technique in 69.7% cases, with 1 (IQR 1-2) median MT pass achieving modified TICI (thrombolysis in cerebral ischemia) scores of 3 and 2b/3 in 74.4% and 95.3% respectively. Our overall first pass effect (FPE, defined as mTICI 3 after firs-pass) and modified FPE (defined as, mTICI 2b/3 after first-pass) rates were 51.1% and 79.1% respectively, with rates of 92.3% and 100% respectively when stentretriever and thromboaspiration were combined. The median reduction in National Institutes of Health Stroke Scale (NIHSS) was 9 (IQR 4-15, p < 0.0001), with a median 90-day modified Rankin Score (mRS) of 1.5 (IQR 0-2). BOBBY BGC use resulted in a high first-pass effect rate and may contribute towards improved functional outcomes.

Stent-Based Retrieval Techniques in Acute Ischemic Stroke Patients with and Without Susceptibility Vessel Sign

Background and PurposeRandomized controlled trials have challenged the assumption that reperfusion success after mechanical thrombectomy varies depending on the retrieval techniques applied; however, recent analyses have suggested that acute ischemic stroke (AIS) patients showing susceptibility vessel sign (SVS) may respond differently. We aimed to compare different stent retriever (SR)-based thrombectomy techniques with respect to interventional outcome parameters depending on SVS status.MethodsWe retrospectively reviewed 497 patients treated with SR-based thrombectomy for anterior circulation AIS. Imaging was conducted using a 1.5 T or 3 T magnetic resonance imaging (MRI) scanner. Logistic regression analyses were performed to test for the interaction of SVS status and first-line retrieval technique. Results are shown as percentages, total values or adjusted odds ratio (aOR) with 95% confidence intervals (CI).ResultsAn SVS was present in 87.9% (n = 437) of patients. First-line SR thrombectomy was used to treat 293 patients, whereas 204 patients were treated with a combined approach (COA) of SR and distal aspiration. An additional balloon-guide catheter (BGC) was used in 273 SR-treated (93.2%) and 89 COA-treated (43.6%) patients. On logistic regression analysis, the interaction variable of SVS status and first-line retrieval technique was not associated with first-pass reperfusion (aOR 1.736, 95% CI 0.491–6.136; p = 0.392), overall reperfusion (aOR 3.173, 95% CI 0.752–13.387; p = 0.116), periinterventional complications, embolization into new territories, or symptomatic intracerebral hemorrhage. The use of BGC did not affect the results.ConclusionWhile previous analyses indicated that first-line SR thrombectomy may promise higher rates of reperfusion than contact aspiration in AIS patients with SVS, our data show no superiority of any particular SR-based retrieval technique regardless of SVS status.

Usefulness of combination usage of balloon guide catheter with contact aspiration thrombectomy.

Angiographic outcomes of contact aspiration thrombectomy (CAT), a frontline thrombectomy strategy, can vary depending on balloon guide catheter (BGC) usage, stroke etiology, and occlusion location. The purpose of this study was to analyze conditional outcomes of CAT to determine which result in maximum angiographic benefits. Patients who received CAT for anterior circulation occlusive stroke between January 2017 and December 2018 were included. Angiographic and clinical outcomes were compared relative to BGC use, stroke etiology, and occlusion location. Multivariable analyses for first-pass reperfusion (FPR) and favorable clinical outcome were performed. Of 160 included patients, the rates of FPR, successful reperfusion after CAT, final successful reperfusion, and favorable clinical outcome were 43.1%, 58.1%, 81.9%, and 60.6%, respectively. BGC use was associated with a higher rate of FPR, successful reperfusion after CAT, a lower rate of distal embolization, and faster reperfusion. Based on subgroup analysis, BGC usage in ICA, MCA M1 occlusion, and cardioembolism were associated with higher FPR, successful reperfusion after CAT, and lower distal embolization. Faster reperfusion was achieved in ICA occlusions and cardioembolisms. BGC usage was an independent predictor of FPR. Favorable clinical outcome was associated with male gender, low initial NIHSS score, fast onset to reperfusion, and FPR. In CAT, BGC usage was associated with better angiographic outcomes, including higher FPR, successful reperfusion after CAT, prevention of distal embolization, and faster reperfusion, especially in proximal occlusions and cardioembolisms. These conditions may play a role in maximizing the benefits of CAT.

Abstract P490: Influence of Balloon Guide Catheter Use on Procedural &amp; Clinical Outcomes in the Escape-NA1 Trial

Purpose: We assessed whether balloon guide catheter (BGC) use during endovascular thrombectomy (EVT) influences procedural and clinical outcomes in the ESCAPE-NA1 trial. Methods: ESCAPE-NA1 was an international multicenter trial that randomized large vessel occlusion stroke patients who underwent endovascular thrombectomy (EVT) to receive Nerinetide vs. placebo. Information on EVT techniques and devices was extracted from angiographic images and procedure report forms. Effect estimates of BGC use on angiographic and clinical outcomes were obtained with logistic regression with adjustment for age, ASPECTS, baseline NIHSS, occlusion site, alteplase and study drug treatment. Results: Detailed information on EVT devices and technique was available for 891/1105 (80.6%) patients. A BGC was used in 599/891 patients (67.2%). BGC use was most common with a retrievable stent use (with or without distal access catheter) as the first-line approach (in 252/266 cases [94.7%] vs. combined approach (both aspiration and SR): 288/414 [69.6%], vs. contact aspiration: 37/159 cases [23.3%]). Overall, eTICI 2b/3 rates with vs. without BGC did not differ significantly (525/598 [87.8%] vs. 260/292 [89.0%]), but eTICI 2c/3 rates were significantly higher when a BGC was used (304/598 [50.8%] vs. 126/292 [43.2%], adjusted OR 1.39 [95%CI 1.05 - 1.9]). Good outcomes (mRS 0-2) were not associated with BGC use (adjusted OR 1.07 [95%CI 0.78 - 1.48]). Conclusion: BGC use was associated with a greater proportion of near-complete reperfusion, while there was no significant association with clinical outcomes.

Abstract P338: Incidence, Predictors and Impact of Infarct in New Territory in Escape Na1 Trial

Introduction: Infarct in new territory (INT) is a known complication of endovascular therapy. We assessed the prevalence, predictors and clinical relevance of INT Methods: We included patients from the ESCAPE-NA1: a multicenter, international randomized study that assessed the efficacy of intravenous nerinetide in patients with acute ischemic stroke who underwent EVT within 12 hours from onset. All imaging was re-evaluated, and INT was defined by presence of infarct in new vascular territory, outside the baseline target occlusion(s) on follow up CT and MRI. INT’s were classified by maximum diameter (&lt;2mm, 2-20mm and &gt;20mm) and location. Results: Of 1099 analyzed patients in ESCAPE NA1, 107 had INT (9.7%, mean age 67 years, 51.4% females). There were no differences at baseline in those with vs without INT. Most INTs (75.7%) were angiographically occult and 41(38.3%) were &gt; 20mm. The most common INT territory was the ACA alone or in combination with MCA/PCA (30.3%). The presence of emboli in new territory angiographically was significantly associated with INT (OR 16.39, 95%CI 8.14-33.09). Alteplase use, balloon guide catheter use, nerinetide and initial occlusion site did not predict INT. INT patients had higher final median infarct volumes compared to non-INT (44.5cc vs 23.3cc, P&lt;0.001). Large INT (diameter of &gt;20mm) were associated with poor clinical outcome compared to INT (&lt;2mm) OR (mRS 0-2) 0.17, 95%CI 0.05-0.55). Conclusion: Infarcts in new territory are common and are associated with poor outcome.

Balloon guide catheter improvements in thrombectomy outcomespersist despite advances in intracranial aspiration technology

BackgroundFirst-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 is Not Superior to Conventional Guide Catheter when Stent Retriever and Contact Aspiration are Combined for Stroke Treatment.

The effectiveness of balloon guide catheter (BGC) use has not been prospectively studied and its added value for improving reperfusion in acute ischemic stroke (AIS) treatment has only been reported in studies in which no contact aspiration was combined with the stent retriever (CA+SR). To compare the reperfusion results and clinical outcomes with and without BGC use when a combined CA+SR strategy is employed in first line to treat AIS. From January 2016 to April 2019, data from the ETIS registry (Endovascular Treatment in Ischemic Stroke) were reviewed. We included patients having undergone endovascular treatment with a combined CA+SR strategy and use or not of a BGC according to the operator's discretion. We compared BGC and nonBGC populations with matching and inverse probability of treatment weighting propensity scores. Primary outcome was the final near-complete/complete revascularization (mTICI2c/3) rate. Secondary outcomes included clinical outcomes and safety considerations. Among 607 included patients, BGC was used in 32.9% (n=200), and 190 matched pairs could be found. We found no significant difference in final mTICI2c/3 between patients with and without BGC (60.1% in BGC group compared to 62.7% in nonBGC group (matched RR, 0.92; 95%CI, 0.80 to 1.14)), first-pass mTICI2c/3 (35.1%vs 37.3%, matched RR, 0.94; 95%CI, 0.68 to 1.30), clinical outcome (matched RR of 1.12 (95%CI, 0.85 to 1.47) for favorable outcome. The reperfusion and clinical results with and without BGC use are not significantly different when combined CA+SR are used as a first-line strategy for large vessel occlusion in the setting of AIS.

Abstract WP26: Use of Balloon-guide Catheter Bridges the Difference in Technical Outcomes Between Adapt and Stent Retriever Thrombectomy for Ischemic Stroke - Insights From STAR Collaboration

Introduction: Recently completed randomized controlled trials comparing aspiration thrombectomy (ADAPT) to stent retriever thrombectomy (SRT) demonstrated similar clinical outcomes, but faster thrombectomy procedure time in the ADAPT group. This study evaluates the difference in technical outcomes between ADAPT and SRT combined with balloon-guide catheters (BGC). Methods: Patients undergoing thrombectomy for acute ischemic stroke at 12 comprehensive stroke centers in the US and Europe between 01/2013 and 12/2018 were reviewed. Data was collected retrospectively from patient charts, procedure notes, and patient follow-up in neurology clinics. Clinical endpoint was the modified Rankin score (mRS) at 90-days, and technical outcomes were procedure time, total attempts, and mTICI scores. Results: The study included 2,016 patients (mean age 69±15) who underwent stroke thrombectomy using ADAPT (46%), SRT (46%), or SRT+BGC (8%). Similar baseline characteristics were observed between the three groups, and no significant difference in mRS scores at 90-days between the three groups in univariate and multivariate analyses. Thrombectomy performed using SRT+BGC required significantly shorter procedure time compared to SRT (35 vs 61 min, p&lt;0.001) that was comparable to ADAPT (36 min, p&gt;0.1). However, use of SRT+BGC required significantly lower number of aspiration attempts compared to ADAPT (median 1 vs. 2, p&lt;0.05). On multivariate linear regression, use of SRT+BGC independent predicted a significant reduction in procedure time compared to SRT (coefficient=-30.6, p&lt;0.001), and significantly lower number of attempts compared to ADAPT (coefficient=-0.4, p=0.01). SRT+BGC was an independent predictor of higher mortality compared to ADAPT (OR=2.4, p&lt;0.01), despite comparable rates of favorable outcomes (mRS 0-2) between the two groups. Use of SRT+BGC was not an independent predictor of symptomatic hemorrhage or complications compared to SRT or ADAPT. Conclusions: This study shows that although ADAPT allows for faster procedure time compared to SRT, the use of BGC in SRT allows for a comparable procedure time to ADAPT with similar overall rates of favorable outcome, complications and hemorrhage. Mortality was higher with the use of BGC compared to ADAPT.

Abstract WP502: Predictors Of First Pass Reperfusion In Anterior Circulation Large Vessel Occlusion Stroke

Introduction: The speed and completeness of endovascular reperfusion strongly correlate with functional outcomes. First-Pass Reperfusion (FPR) has been recently established as a critical procedural performance metric for mechanical thrombectomy (MT). We aimed to study the predictors of FPR and its effect on the outcome Methods: Review of a prospectively collected database of MT patients with large vessel occlusion strokes (LVOS) from 05/2012-11/2018. Patients were included in the analysis if they had an anterior circulation LVOS that was successfully reperfused (mTICI 2b-3). FPR was defined as the achievement of mTICI 2c-3 after a single pass with any thrombectomy device. Uni- and multivariate analyses were performed to identify the independent predictors of FPR. Results: A total of 563 patients qualified for the analysis (mean age, 64.4±12.3 years, baseline NIHSS 16.2). FPR was achieved in 202 (35.9%) patients. On univariate analysis, FPR was significantly associated with higher ASPECTS (8.1 vs. 7.8, p=0.008), higher usage of balloon guide catheters (BGC) (88.1% vs. 75.3%, p&lt;0.001), lower use of general anesthesia (9.5% vs. 18.2%, p= 0.006), and shorter procedure duration (mean, 45.5 vs. 79.9 min, p &lt;0.001 and 90.5%). Both BGC (OR, 2.26; 95%CI [1.32-3.87], p=0.003) and ASPECTS (OR, 1.15; 95% CI [1.03-1.28], p= 0.01) were independent predictors of FPE on multivariate regression analysis. Conclusion: Higher baseline ASPECTS score and the use of BGC are strong predictors of First-Pass Reperfusion in mechanical thrombectomy.