Background Previous studies favoring the use of balloon guide catheters (BGCs) during endovascular thrombectomy for anterior circulation acute ischemic stroke either predate advancements in catheter technology or inadequately adjust for large-bore aspiration catheters. This study compared angiographic and clinical outcomes for stroke thrombectomy performed without and with BGCs. Methods This multicenter, retrospective study analyzed matched anterior circulation thrombectomy cases performed between February 2018 and February 2024. BGC and non-BGC cases were 1:1 matched by demographic and clinical variables. Primary outcome measures were successful reperfusion (modified thrombolysis in cerebral infarction ≥2B) and good clinical outcome (modified Rankin Scale score 0–2 at discharge and 30 days). Results Among 407 patients (non-BGC=199, BGC=208), BGC use had higher rates of successful reperfusion (83.9% vs 90.9%, P=0.034) and better functional outcomes at discharge (18.7% vs 28.4%, P=0.022) and 30 days (21.1% vs 31.3%, P=0.020). On multivariable analysis, BGC independently predicted successful reperfusion (OR 2.29, 95% CI 1.56 to 3.77, P=0.02) and good outcomes at discharge (OR 1.87, 95% CI 1.14 to 3.07, P=0.01) and 30 days (OR 1.89, 95% CI 1.18 to 3.03, P=0.01). Subgroup analysis demonstrated that BGC use was most beneficial in patients with times from last known well to puncture ≤6 hours, with higher rates of successful reperfusion (84.5% vs 94.6%, P=0.041) and favorable outcomes at discharge (14.5% vs 32.4%, P=0.007) and 30 days (23.8% vs 39.2%, P=0.037). Conclusion BGC use during endovascular thrombectomy is associated with higher rates of successful reperfusion and better early functional outcomes, particularly in patients treated within 6 hours of last-known-well time.
Gautam et al. (Tue,) studied this question.