Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA.
Research, Jacksonville University, Jacksonville, Florida, USA.
J Neurointerv Surg. 2022 Mar;14(3):280-285. doi: 10.1136/neurintsurg-2021-017494. Epub 2021 Apr 15.
The use of a balloon-guide catheter (BGC) in acute stroke treatment has been widely adopted after demonstrating optimized procedure metrics and outcomes. Initial technical constraints of previous devices included catheter stiffness and smaller inner diameters. We aim to evaluate the performance and safety of the Walrus BGC, a variable stiffness catheter with a large bore 0.087 inch inner diameter (ID), via the the WICkED study (alrus Large Bore guide Catheter mpact on reanalization first pass ffect an outcomes).
This is a retrospective, site adjudicated, multicenter study on consecutive patients with large vessel occlusion treated with the Walrus BGC. Baseline characteristics, procedural outcomes and functional outcomes were analyzed.
A total of 338 patients met the inclusion criteria. The Walrus was successfully tracked into distal vasculature and allowed therapeutic device delivery in all but 3 cases (0.9%). Large aspiration catheters ≥0.070 inch ID were used in 71.9% of cases. Stent retriever thrombectomy was used as the first-line modality in 59.2% and thromboaspiration in 40.8% of cases. The successful recanalization rate (modified treatment in cerebral ischemia (mTICI) 2b/3) was 94.4%, with 64.8% of the patients achieving mTICI 2b/3 after the first pass. The Walrus-related adverse event rate was 0.6%, corresponding to two vessel dissections. Functional independence was 50% (126/252) and mortality 25% (63/252). Unfavorable outcomes were more likely in older patients, who had unsuccessful reperfusion, longer procedure times, and a higher mean number of passes.
In acute ischemic stroke patients presenting with large vessel occlusion, the Walrus BGC demonstrated excellent navigability and safety profile, allowed the accommodation of leading large bore aspiration catheters, and demonstrated high vessel recanalization rates.
在急性脑卒中治疗中，球囊引导导管（BGC）的使用已经得到广泛应用，因为它可以优化手术的各项指标和结果。早期的设备存在技术限制，如导管的硬度和较小的内直径。我们旨在通过 WICkED 研究评估 Walrus BGC 的性能和安全性，这是一种可变硬度导管，其具有较大的 0.087 英寸内径（ID）。
这是一项回顾性、多中心、现场裁决的研究，纳入了接受 Walrus BGC 治疗的大血管闭塞患者。分析了患者的基线特征、手术结果和功能结局。
共有 338 名患者符合纳入标准。除了 3 例（0.9%）外，Walrus 均成功追踪至远端血管并允许输送治疗设备。≥0.070 英寸 ID 的大抽吸导管在 71.9%的病例中使用。支架取栓术作为一线治疗方法在 59.2%的病例中使用，血栓抽吸术在 40.8%的病例中使用。成功再通率（改良脑梗死治疗（mTICI）2b/3）为 94.4%，64.8%的患者在第一次通过时达到 mTICI 2b/3。与 Walrus 相关的不良事件发生率为 0.6%，对应两例血管夹层。功能独立性为 50%（126/252），死亡率为 25%（63/252）。年龄较大的患者更有可能出现不良结局，他们的再灌注不成功、手术时间更长、平均通过次数更多。
在急性缺血性脑卒中患者中，大血管闭塞患者使用 Walrus BGC 表现出良好的可操作性和安全性，能够容纳较大的抽吸导管，并显示出较高的血管再通率。
