Emergency Balloon Catheter Improves Outcomes in Acute Ischemic Stroke Thrombectomy

Introduction/Purpose Balloon guide catheters (BGCs) may improve recanalization outcomes in mechanical thrombectomy by providing proximal flow control and reducing distal embolization. We evaluated the safety and efficacy of EMBOGUARD ™ compared to conventional guide catheters in acute ischemic stroke thrombectomy. Materials/Methods Consecutive patients undergoing mechanical thrombectomy for stroke at four thrombectomy‐capable centers from January 2022 to December 2024 were retrospectively analyzed and stratified by use of EMBOGUARD ™ versus conventional guide catheters. Patients were eligible for inclusion if they were aged 18‐85 years with an initial NIHSS score >5, had a last known well time to procedure start <24 hours, demonstrated baseline functional independence (mRS 0‐1), and presented with involvement of intracranial vessels including the internal carotid artery beyond the petrous segment and/or middle cerebral artery. Patients were excluded if they had tandem ipsilateral proximal extracranial stenosis, previous stent placement in the target lesion, steno‐occlusive disease related to intracranial atherosclerotic disease with ≥50% stenosis/occlusion, pre‐treatment CT ASPECTS <5, any intracranial hemorrhage within the prior 30 days, or untreated chronic subdural hematoma >5 mm thickness. The primary outcome was first‐pass effect (modified TICI [mTICI] ≥2c in a single pass without adjunctive treatment). Secondary outcomes included successful recanalization (mTICI ≥2b), favorable functional outcome (mRS 0‐2 at 90 days), procedural metrics, and safety endpoints. Univariate comparisons, propensity score matching (PSM), sensitivity analyses (by site and vessel), and missing data analysis were performed. Results Among 178 patients (EMBOGUARD ™ n=135; conventional n=43), baseline characteristics were balanced except for higher atrial fibrillation (33.3% vs 20.9%, p=0.044) and intracranial ICA occlusions (17.8% vs 9.3%, p=0.012) with EMBOGUARD ™ . First‐pass effect occurred in 33.3% (45/135) with EMBOGUARD ™ vs 37.2% (16/43) with conventional catheters (p=0.678). Successful recanalization rates were similar (86.7% vs 86.0%, p=0.924). A higher proportion of EMBOGUARD ™ patients achieved favorable 90‐day outcomes (45.7% vs 22.5%, p=0.012). Procedural time was numerically shorter with EMBOGUARD ™ (43.3±35.3 vs 54.2±30.3 min, p=0.089). Symptomatic intracerebral hemorrhage (2.0% vs 0.0%, p=0.373) and 90‐day mortality (13.7% vs 16.7%, p=0.656) were comparable. PSM validated these findings, confirming no difference in first‐pass effect and a persistent benefit in functional outcome (43.2% vs 22.5%, p=0.047). Sensitivity analyses by vessel occlusion revealed first‐pass effect rates for ICA: 50.0% vs 25.0%; M1: 44.8% vs 45.0%; beyond M1: 6.8% vs 31.6% (EMBOGUARD ™ vs conventional, respectively). Two centers adopted only EMBOGUARD ™ . Conclusion In this multicenter retrospective study, EMBOGUARD ™ balloon guide catheter was not superior to conventional guide catheters for first‐pass effect but was associated with significantly better 90‐day functional outcomes. Operator experience, case selection, and site‐level adoption may influence effectiveness; prospective trials are needed.