Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Spain
IDI-Radiology, Doctor Josep Trueta University Hospital of Girona, Girona, Spain.
J Neurointerv Surg. 2022 Sep;14(9):863-867. doi: 10.1136/neurintsurg-2021-017760. Epub 2021 Aug 27.
Balloon guide catheter (BGC) in stent retriever based thrombectomy (BGC+SR) for patients with large vessel occlusion strokes (LVOS) improves outcomes. It is conceivable that the addition of a large bore distal access catheter (DAC) to BGC+SR leads to higher efficacy. We aimed to investigate whether the combined BGC+DAC+SR approach improves angiographic and clinical outcomes compared with BGC+SR alone for thrombectomy in anterior circulation LVOS.
Consecutive patients with anterior circulation LVOS from June 2019 to November 2020 were recruited from the ROSSETTI registry. Demographic, clinical, angiographic, and outcome data were compared between patients treated with BGC+SR alone versus BGC+DAC+SR. The primary outcome was first pass effect (FPE) rate, defined as near complete/complete revascularization (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) after single device pass.
We included 401 patients (BGC+SR alone, 273 (66.6%) patients). Patients treated with BGC+SR alone were older (median age 79 (IQR 68-85) vs 73.5 (65-82) years; p=0.033) and had shorter procedural times (puncture to revascularization 24 (14-46) vs 37 (24.5-63.5) min, p<0.001) than the BGC+DAC+SR group. Both approaches had a similar FPE rate (52% in BGC+SR alone vs 46.9% in BGC+DAC+SR, p=0.337). Although the BGC+SR alone group showed higher rates for final successful reperfusion (mTICI ≥2b (86.8% vs 74.2%, p=0.002) and excellent reperfusion, mTICI ≥2 c (76.2% vs 55.5%, p<0.001)), there were no significant differences in 24 hour National Institutes of Health Stroke Scale score or rates of good functional outcome (modified Rankin Scale score of 0-2) at 3 months across these techniques.
Our data showed that addition of distal intracranial aspiration catheters to BGC+SR based thrombectomy in patients with acute anterior circulation LVO did not provide higher rates of FPE or improved clinical outcomes.
在支架取栓术（SR）中使用球囊引导导管（BGC）治疗大血管闭塞性卒中（LVOS）可改善预后。可以想象，在 BGC+SR 中增加大口径远端通路导管（DAC）会提高疗效。我们旨在研究与单独使用 BGC+SR 相比，在前循环 LVOS 的取栓术中联合 BGC+DAC+SR 方法是否能改善血管造影和临床结局。
连续纳入 2019 年 6 月至 2020 年 11 月 ROSSETTI 登记处的前循环 LVOS 患者。比较单独使用 BGC+SR 治疗的患者与 BGC+DAC+SR 治疗的患者的人口统计学、临床、血管造影和结局数据。主要结局是首次通过效果（FPE）率，定义为单次器械通过后接近完全/完全再通（改良脑梗死溶栓（mTICI）2c-3）。
共纳入 401 例患者（单独使用 BGC+SR 治疗的患者 273 例（66.6%））。单独使用 BGC+SR 治疗的患者年龄更大（中位数 79（IQR 68-85）岁 vs 73.5（65-82）岁；p=0.033），手术时间更短（穿刺至再通 24（14-46）分钟 vs 37（24.5-63.5）分钟；p<0.001）。两种方法的 FPE 率相似（单独使用 BGC+SR 组为 52%，BGC+DAC+SR 组为 46.9%；p=0.337）。尽管单独使用 BGC+SR 组的最终成功再灌注率更高（mTICI≥2b（86.8% vs 74.2%，p=0.002）和良好的再灌注，mTICI≥2c（76.2% vs 55.5%，p<0.001）），但在这两种技术中，24 小时 NIHSS 评分或 3 个月时良好功能结局（改良 Rankin 量表评分 0-2）的比例均无显著差异。
我们的数据表明，在前循环急性 LVO 患者的 BGC+SR 基础取栓术中增加远端颅内抽吸导管并不能提高 FPE 率或改善临床结局。
