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Impact of balloon guide catheter on technical and clinical outcomes: a systematic review and meta-analysis
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  • Published on:
    Response to “Impact of balloon guiding catheter on technical and clinical outcomes: a systematic review and meta-analysis”
    • Jin Pyeong Jeon, Neurosurgeon Hallym University College of Medicine
    • Other Contributors:
      • Jun Hyong Ahn, neurosurgeon
      • Sung-Eun Kim, Emergency medicine doctor

    I read with great interest the meta-analysis by Brinjikji et al.1 which evaluated outcomes after mechanical thrombectomy for acute ischemic stroke by using a balloon guiding catheter (BGC) device. In that study, the authors documented that patients who underwent mechanical thrombectomy with BGC had better clinical and angiographic outcomes than those without BGC. However, there were some issues which should be addressed and discussed.
    First, the number of successful recanalizations, shown as 2b/3 of Thrombolysis In Cerebral Infarction (TICI) grade in Fig.3 in the article,1 might be not accurately described. The events of successful recanalization were noted in 113 of 149 in the BGC group and 133 of 189 in the non-BGC group according to Nguyen et al.2 However, the events were presented as 112 of 149 in the BGC group and 135 of 189 in the non-BGC group.1 Accordingly, the forest plot can be changed as in Fig. 1 below. Mechanical thrombectomy using BGC exhibited significantly higher successful recanalizations than did non-BGC use (OR, 1.710; 95% CI: 1.099-2.662). Second, there was no specific explanation for the publication bias of Fig. 4 in the result section.1 Although the authors reported a p value of 0.49 using Egger’s regression, we are not sure what publication bias meant to represent, successful recanalization or clinical outcome or other variables.
    In this letter, we made a funnel plot for successful recanalization based on the revised number of events we h...

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    Conflict of Interest:
    None declared.
  • Published on:
    Comments on Impact of balloon guide catheter on technical and clinical outcomes: a systematic review and meta-analysis
    • Michel Piotin, interventional neuroradiologist Foundation Rothschild Hospital
    • Other Contributors:
      • Raphaël Blanc, interventional neuroradiologist
      • Bertrand Lapergue, neurologist

    We read with interest the meta-analysis conducted by our colleague Dr Waleed Brinjikji (1). In the text (section "Limitations", he stated: "Data from the Interest of Direct Aspiration First Pass Technique (ADAPT) for Thrombectomy Revascularization of Large Vessel Occlusion in Acute Ischemic Stroke (ASTER) trial suggest that there were no statistically significant differences in revascularization rates when performing the ADAPT technique compared with using a stent retriever. However, it is unclear at this time whether BGCs were used in this trial."
    Nevertheless in our publication of the ASTER trial results (2), we clearly stated in the Results section that a balloon-guide catheter was used to allow proximal flow arrest during stent retriever removal in 92% of patients treated with the stent retriever technique.
    1. Brinjikji W, Starke RM, Murad MH, et al. Impact of balloon guide catheter on technical and clinical outcomes: a systematic review and meta-analysis. J Neurointerv Surg 2018;10:335–339.
    2. Lapergue B, Blanc R, Gory B, et al. JAMA. 2017;318:443-452.

    Conflict of Interest:
    None declared.