Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
J Neurointerv Surg. 2024 Jan 12;16(2):124-130. doi: 10.1136/jnis-2023-020114.
Extensive clot burden in tandem strokes accounts for poor mechanical thrombectomy (MT) outcomes. Several studies have shown the benefit of balloon guide catheters (BGCs) in MT and carotid artery stenting.
In view of this potential benefit, to investigate the safety and effectiveness of proximal flow arrest using a BGC during concurrent MT and carotid revascularization for tandem stroke treatment in a comparative, propensity score-matched (PSM) study.
Patients with a tandem stroke identified from our endovascular database were dichotomized into groups treated with BGCs versus conventional guide catheters. One-to-one PSM adjustment for baseline demographics and treatment selection bias using nearest-neighbor matching was performed. Patient demographics, presentation characteristics, and procedural details were recorded. Outcomes assessed were final modified Thrombolysis in Cerebral Infarction (mTICI) grade, periprocedural symptomatic intracranial hemorrhage (sICH) rate, in-hospital mortality, and 90-day modified Rankin Scale (mRS) score. Mann-Whitney U test and multivariate logistic regression were performed to compare procedural parameters and clinical outcomes.
Concurrent carotid revascularization (stenting with/without angioplasty) and MT was performed in 125 cases (BGC: 85; no BGC: 40). After PSM (40 patients/group), the BGC group had a significantly shorter procedure duration (77.9 vs 61.5 min; OR=0.996; P=0.006), lower discharge National Institutes of Health Stroke Scale score (8.0 vs 11.0; OR=0.987; P=0.042), and higher odds of 90-day mRS 0-2 score (52.3% vs 27.5%; OR=0.34; P=0.040). On multivariate regression, the BGC group had a significantly higher first pass effect rate (mTICI 2b or 3)(OR=1.115, 95% CI 1.015 to 1.432; P=0.013) and lower periprocedural sICH rate (OR=0.615, 95% CI 0.406 to 0.932; P=0.025). No difference in in-hospital mortality was observed (OR=1.591, 95% CI 0.976 to 2.593; P=0.067).
BGCs used for concurrent MT-carotid revascularization with flow arrest were safe and resulted in superior clinical and angiographic outcomes in patients with a tandem stroke.
串联性卒中的广泛血栓负荷导致机械血栓切除术（MT）效果不佳。几项研究表明，球囊引导导管（BGC）在 MT 和颈动脉支架置入术中具有益处。
鉴于这种潜在的益处，在一项对比性、倾向评分匹配（PSM）研究中，我们旨在探讨在同时进行 MT 和颈动脉血运重建治疗串联性卒中时，近端血流阻断使用 BGC 的安全性和有效性。
从我们的血管内数据库中确定的串联性卒中患者分为 BGC 组和常规引导导管组。使用最近邻匹配进行了基于基线人口统计学和治疗选择偏倚的 1:1 PSM 调整。记录患者的人口统计学、临床表现和手术细节。评估的结果是最终改良脑梗死溶栓（mTICI）分级、围手术期症状性颅内出血（sICH）发生率、住院死亡率和 90 天改良 Rankin 量表（mRS）评分。采用 Mann-Whitney U 检验和多变量逻辑回归比较手术参数和临床结果。
125 例患者同时进行了颈动脉血运重建（支架置入术伴/不伴血管成形术）和 MT（BGC：85 例；无 BGC：40 例）。PSM（每组 40 例）后，BGC 组的手术时间明显缩短（77.9 分钟 vs 61.5 分钟；OR=0.996；P=0.006），出院时国立卫生研究院卒中量表评分较低（8.0 分 vs 11.0 分；OR=0.987；P=0.042），90 天 mRS 0-2 评分的可能性更高（52.3% vs 27.5%；OR=0.34；P=0.040）。多变量回归分析显示，BGC 组的首次通过效果率（mTICI 2b 或 3）明显更高（OR=1.115，95%CI 1.015 至 1.432；P=0.013），围手术期 sICH 发生率较低（OR=0.615，95%CI 0.406 至 0.932；P=0.025）。两组住院死亡率无差异（OR=1.591，95%CI 0.976 至 2.593；P=0.067）。
在同时进行 MT-颈动脉血运重建并使用 BGC 阻断血流的情况下，BGC 是安全的，可改善串联性卒中患者的临床和血管造影结果。
