Key result
Compliant balloon thrombolysis shows no significant recanalization benefit over simple mechanical thrombolysis in acute stroke.
Why the study?
The usefulness of a compliant balloon for recanalization in acute ischemic stroke patients resistant to simple mechanical thrombolysis was not well established.
Does the use of a compliant balloon improve vessel recanalization in acute ischemic stroke patients compared to simple mechanical thrombolysis?
Cohort (n=46)
No
Does the use of a compliant balloon improve vessel recanalization in acute ischemic stroke patients compared to simple mechanical thrombolysis?
The use of a compliant balloon for intraarterial thrombolysis in acute ischemic stroke improves the quality of recanalization (TICI 2b) and reduces intraparenchymal hemorrhage compared to simple mechanical thrombolysis.
Compliant balloon use showed no significant recanalization advantage; leaves open potential benefits in TICI 2b quality and hemorrhage reduction.
OBJECTIVE: We report on our experience using a compliant balloon for treatment of thrombi resistant to simple mechanical thrombolysis. METHODS: We conducted a retrospective investigation of 46 consecutive acute ischemic stroke patients who were treated by intraarterial thrombolysis (IAT) between January 2008 and July 2010. We compared IAT results between the balloon group (BG) and the simple mechanical thrombolysis (with microcatheter and microguidewire) group (SG). The Thrombolysis in Myocardial Infarction (TIMI) grading system was used for grading of the degrees of vessel recanalization. In addition, a modified Thrombolysis in Cerebral Infarction (TICI) score was used for post-IAT TIMI grade 2 patients. Modified Rankin Scale scores were used at three months for assessment of clinical outcomes. RESULTS: Twenty of the 46 subjects were treated with a compliant balloon. The mean initial National Institutes of Health Stroke Scale score was 15.1 in the BG and 14 in the SG. The mean time from symptom onset to initiation of IAT was 225 minutes in the BG and 177 in the SG (p = 0.004). The overall rate of successful recanalization (TIMI grade 2 or 3) was 85% in the BG and 73% in the SG (p = 0.476). In the TIMI grade 2 group, modified TICI 2b was 90% in the BG and 16% in the SG (p = 0.001). Postprocedure intraparenchymal hemorrhage occurred in two subjects in the BG and 10 subjects in the SG (p = 0.029). No significant difference in clinical outcomes was observed between the BG and SG (p = 0.347). CONCLUSIONS: The compliant balloon showed high potential for recanalization following acute ischemic stroke, especially when simple mechanical thrombolysis had failed.
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Kang et al. (2012) conducted a cohort in Acute Ischemic Stroke (n=46). Compliant balloon thrombolysis vs. Simple mechanical thrombolysis (microcatheter and microguidewire) was evaluated on Successful recanalization (TIMI grade 2 or 3) (p=0.476). The use of a compliant balloon for acute ischemic stroke resulted in an 85% successful recanalization rate compared to 73% with simple mechanical thrombolysis, which was not statistically significant (p=0.476).
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