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Original research
Impact of balloon guide catheter on technical and clinical outcomes: a systematic review and meta-analysis
  1. Waleed Brinjikji1,2,3,
  2. Robert M Starke4,5,
  3. M Hassan Murad6,
  4. David Fiorella7,
  5. Vitor M Pereira8,
  6. Mayank Goyal9,
  7. David F Kallmes1,2
  1. 1Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Department of Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Neurological Surgery, Miami Miller School of Medicine, University of Miami Hospital, Miami, Florida, USA
  5. 5Department of Radiology, University of Miami Hospital, Miami Miller School of Medicine, Miami, Florida, USA
  6. 6Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
  7. 7Department of Neurosurgery, State University of New York at Stony Brook, Stony Brook University Medical Center, Stony Brook, New York, USA
  8. 8Department of Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
  9. 9Department of Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Waleed Brinjikji, Department of Radiology, Mayo Clini, Rochester, MN 55905 Minnesota; brinjikji.waleed{at}gmail.com

Abstract

Background and purpose Flow arrest with balloon guide catheters (BGCs) is becoming increasingly recognized as critical to optimizing patient outcomes for mechanical thrombectomy. We performed a systematic review and meta-analysis of the literature for studies that compared angiographic and clinical outcomes for patients who underwent mechanical thrombectomy with and without BGCs.

Materials and methods In April 2017 a literature search on BGC and mechanical thrombectomy for stroke was performed. All studies included patients treated with and without BGCs using modern techniques (ie, stent retrievers). Using random effects meta-analysis, we evaluated the following outcomes: first-pass recanalization, Thrombolysis In Cerebral Infarction (TICI) 3 recanalization, TICI 2b/3 recanalization, favorable outcome (modified Rankin Scale (mRS) 0–2), mortality, and mean number of passes and procedure time.

Results Five non-randomized studies of 2022 patients were included (1083 BGC group and 939 non-BGC group). Compared with the non-BGC group, patients treated with BGCs had higher odds of first-pass recanalization (OR 2.05, 95% CI 1.65 to 2.55), TICI 3 (OR 2.13, 95% CI 1.43 to 3.17), TICI 2b/3 (OR 1.54, 95% CI 1.21 to 1.97), and mRS 0–2 (OR 1.84, 95% CI 1.52 to 2.22). BGC-treated patients also had lower odds of mortality (OR 0.52, 95% CI 0.37 to 0.73) compared with non-BGC patients. The mean number of passes was significantly lower for BGC-treated patients (weighted mean difference −0.34, 95% CI−0.47 to −0.22). Mean procedure time was also significantly shorter for BGC-treated patients (weighted mean difference −7.7 min, 95% CI−9.0to −6.4).

Conclusions Non-randomized studies suggest that BGC use during mechanical thrombectomy for acute ischemic stroke is associated with superior clinical and angiographic outcomes. Further randomized trials are needed to confirm the results of this study.

  • mechanical thrombectomy
  • stroke

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Footnotes

  • Twitter @wbrinjikji

  • Contributors WB, RMS, DF, DFK, VMP, and MG made (1) substantial contributions to the conception or design of the work or the acquisition, analysis or interpretation of data for the work; (2) drafting of the work or revising it critically for important intellectual content; (3) final approval of the version to be published; and (4) are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding WB is CEO of Marblehead Medical LLC and has patents pending in balloon catheter technologies. DFK is President of Marblehead Medical LLC and has patents pending in balloon catheter technologies. There are no other relevant disclosures.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data can be made available by contacting the corresponding author via email.

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