315 A Propensity Score-matched Comparative Study of Balloon Guide Catheters Versus Conventional Guide Catheters for Mechanical Thrombectomy With Stenting in Tandem Strokes: Comparison of 1st-pass Effect, Symptomatic ICH, and 90-day Functional Outcomes

INTRODUCTION: Extensive clot burden in tandem strokes accounts for poor mechanical thrombectomy (MT) outcomes. Several studies have shown benefit of balloon guide catheters (BGC) in MT and carotid artery stenting. METHODS: Tandem stroke patients identified from our endovascular database were dichotomized into groups treated with BGCs versus conventional guide catheters. One-to-one PSM adjustment for baseline demographics and treatment selection bias using nearest-neighbor matching was performed. Patient demographics, presentation characteristics, and procedural details were recorded. Outcomes assessed were final modified thrombolysis in cerebral infarction (mTICI) grade, periprocedural symptomatic intracranial hemorrhage (sICH) rate, in-hospital mortality, and 90-day modified Rankin Scale (mRS) score. Mann-Whitney U-test and multivariate logistic regression were performed to compare procedural parameters and clinical outcomes. RESULTS: Concurrent carotid revascularization (stenting with/without angioplasty) and MT was performed in 125 cases (BGC: 85; no BGC: 40). After PSM (40 patients/group), BGC group had a significantly shorter procedure duration (77.9 vs. 61.5 min; odds ratio [OR] = 0.996; p = 0.006), lower discharge National Institutes of Health Stroke Scale score (8.0 vs. 11.0; OR = 0.987; p = 0.042), and higher odds of 90-day mRS 0-2 score (52.3% vs. 27.5%; OR = 0.34; p = 0.040). On multivariate regression, BGC group had a significantly higher first-pass effect rate (mTICI: 2B-3) (OR = 1.115, 95% confidence interval [CI] = 1.015-1.432; p = 0.013) and 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: BGCs used for concurrent MT–carotid revascularization with flow arrest were safe and resulted in superior clinical and angiographic outcomes in tandem stroke patients.