Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Room 4.R1.032, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Room 4.R1.032, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
J Vasc Interv Radiol. 2019 Nov;30(11):1759-1764.e6. doi: 10.1016/j.jvir.2019.05.032. Epub 2019 Sep 18.
To compare outcomes after endovascular treatment (EVT) for acute ischemic stroke with and without the use of a balloon guide catheter (BGC) in clinical practice.
Data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN) Registry were used, in which all patients who underwent EVT for anterior-circulation stroke in The Netherlands between 2014 and 2016 were enrolled. Primary outcome was modified Rankin scale (mRS) score at 90 days. Secondary outcomes included reperfusion grade (extended Thrombolysis In Cerebral Infarction [eTICI] score) and National Institutes of Health Stroke Scale (NIHSS) score 24-48 hours after intervention. The association between the use of a BGC and outcomes was estimated with logistic regression adjusted for age, sex, prestroke mRS score, NIHSS score, collateral grade, and time from onset to EVT.
A total of 887 patients were included. Thrombectomy was performed with the use of a BGC in 528 patients (60%) and without in 359 patients (40%). There was no significant association between use of a BGC and a shift on the mRS toward better outcome (adjusted common odds ratio, 1.17; 95% confidence interval [CI], 0.91-1.52). Use of a BGC was associated with higher eTICI score (adjusted common OR, 1.33; 95% CI, 1.04-1.70) and improvement of ≥ 4 points on the NIHSS (adjusted OR, 1.40; 95% CI, 1.04-1.88).
In clinical practice, use of a BGC was associated with higher reperfusion grade and early improvement of neurologic deficits, but had no positive effect on long-term functional outcome.
比较临床实践中急性缺血性脑卒中血管内治疗（EVT）中使用和不使用球囊引导导管（BGC）的结果。
使用荷兰急性缺血性卒中血管内治疗多中心随机临床试验（MR CLEAN）登记处的数据，该登记处纳入了 2014 年至 2016 年期间荷兰所有接受前循环卒中 EVT 的患者。主要结局为 90 天时改良 Rankin 量表（mRS）评分。次要结局包括再灌注分级（扩展脑梗死溶栓分级[eTICI]评分）和干预后 24-48 小时的国立卫生研究院卒中量表（NIHSS）评分。使用逻辑回归估计 BGC 使用与结局之间的关联，调整了年龄、性别、基线 mRS 评分、NIHSS 评分、侧支循环分级和 EVT 发病至治疗时间。
共纳入 887 例患者。528 例（60%）患者使用 BGC 进行血栓切除术，359 例（40%）患者未使用 BGC。使用 BGC 与 mRS 评分向更好结局的转变无显著相关性（调整后的常见比值比，1.17；95%置信区间[CI]，0.91-1.52）。使用 BGC 与更高的 eTICI 评分（调整后的常见比值比，1.33；95% CI，1.04-1.70）和 NIHSS 评分至少改善 4 分（调整后的比值比，1.40；95% CI，1.04-1.88）相关。
在临床实践中，BGC 的使用与更高的再灌注分级和神经功能缺损的早期改善相关，但对长期功能结局没有积极影响。
