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BACKGROUND: While balloon guide catheters (BGCs) are widely used during endovascular thrombectomy (EVT) for large vessel occlusions, prior studies evaluated heterogeneous occlusion locations. The specific benefits of BGCs in M1, or more distal middle cerebral artery (MCA) occlusions remain uncertain. METHODS: We retrospectively analyzed 61 patients with acute ischemic stroke due to M1, M2, or proximal M3 occlusion who underwent EVT at two tertiary centers between January 2020 and December 2021. Patients were treated using the stent retriever thrombectomy (SRT), direct aspiration first-pass technique (ADAPT), or combined techniques, with or without BGC, at the operator's discretion. Primary endpoints were successful recanalization (mTICI ≥2b), first-pass recanalization, and procedural time. Clinical outcomes included the 90-day modified rankin scale (mRS), symptomatic intracranial hemorrhage, and mortality. RESULTS: Among the 61 patients (mean age 68.9 ± 12.8 years), 35 (57.4%) were treated with BGC. Successful recanalization rates were similar between the BGC and non-BGC groups (88.6% vs. 92.3%, P = 0.960). However, first-pass recanalization was lower in the BGC group (42.9% vs. 69.2%, P = 0.041), and procedural time was longer (57.1 ± 29.6 vs. 38.4 ± 19.7 min, P = 0.005). No significant differences were observed in functional independence at 90 days (40.0% vs. 50.0%, P = 0.440), symptomatic hemorrhage, or mortality. In multivariate logistic regression adjusting for age, baseline NIHSS, occlusion site, and recanalization success, BGC use was not independently associated with good functional outcome. CONCLUSION: In M1 and more distal MCA occlusions, BGC use was not associated with improved angiographic or clinical outcomes and was linked to lower first-pass recanalization rates and longer procedural times. These exploratory findings indicate that the utility of BGCs may depend on the occlusion location and procedural context, supporting a more tailored approach to device selection rather than a uniform preference for BGC use.
Kim et al. (Wed,) studied this question.