Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
IDI-Radiology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Catalunya, Spain.
J Neurointerv Surg. 2021 Sep;13(9):773-778. doi: 10.1136/neurintsurg-2020-017027. Epub 2021 Feb 25.
First-pass effect (FPE) has been established as a key metric for technical success and strongly correlates with better clinical outcomes. Most data supporting improved outcomes with the use of a balloon guide catheter (BGC) predate the advent of last-generation large-bore intracranial aspiration catheters. We aim to evaluate the impact of BGC in FPE and clinical outcomes in a large cohort of patients treated with contemporary technology.
Patients were recruited from the prospectively ongoing ROSSETTI registry. This registry includes all consecutive patients with anterior circulation large-vessel occlusion (LVO) from 10 comprehensive stroke centers in Spain. Demographic, clinical, angiographic, and clinical outcome data were compared between BGC and non-BGC groups. FPE was defined as the achievement of mTICI2c-3 after a single device pass.
426 patients were included out of which 271 (63.62%) used BCG. BGC-treated patients had higher FPE rate (45.8% vs 27.7%; P<0.001), higher final mTICI ≥2 c recanalization rate (76.8% vs 50.3%, respectively; P<0.001), shorter procedural time [median (IQR), 30 (19-58) vs 43 (33-71) min; P<0.001], higher NIHSS difference from admission to 24 hours [median (IQR), 8 (2-12) vs 3 (0-10); P=0.001], and lower mortality rate (17.6% vs 29.8%, P=0.026) compared with non-BGC patients. BGC use was an independent predictor of FPE (OR 2.197, 95% CI 1.436 to 3.361; P<0.001), and excellent clinical outcome at 3 months (OR 0.34, 95% CI 0.17 to 0.68; P=0.002).
Our results support the benefit of BGC use on angiographic and clinical outcomes in anterior circulation LVO ischemic stroke remain significant even when considering recent improvements in intracranial aspiration technology.
首过效应（FPE）已被确立为技术成功的关键指标，并与更好的临床结果密切相关。大多数支持使用球囊引导导管（BGC）提高疗效的数据都早于新一代大口径颅内抽吸导管的问世。我们旨在评估 BGC 在 FPE 中的作用，并评估其在使用当代技术治疗的大量患者中的临床结局。
患者从正在进行的 ROSSETTI 注册研究中招募。该注册研究包括来自西班牙 10 个综合卒中中心的前循环大血管闭塞（LVO）的所有连续患者。比较 BGC 和非 BGC 组的人口统计学、临床、血管造影和临床结局数据。FPE 定义为单次器械通过后达到 mTICI2c-3。
共纳入 426 例患者，其中 271 例（63.62%）使用 BGC。BGC 治疗的患者 FPE 率更高（45.8%比 27.7%；P<0.001），最终 mTICI≥2c 再通率更高（76.8%比 50.3%；P<0.001），手术时间更短[中位数（IQR），30（19-58）比 43（33-71）min；P<0.001]，入院至 24 小时 NIHSS 差值更高[中位数（IQR），8（2-12）比 3（0-10）；P=0.001]，死亡率更低（17.6%比 29.8%；P=0.026）。与非 BGC 患者相比。BGC 使用是 FPE 的独立预测因素（OR 2.197，95%CI 1.436 至 3.361；P<0.001），3 个月时良好的临床结局（OR 0.34，95%CI 0.17 至 0.68；P=0.002）。
即使考虑到颅内抽吸技术的最新进展，我们的结果仍支持在前循环 LVO 缺血性卒中患者中使用 BGC 对血管造影和临床结局的益处。
