Introduction/Purpose Extensive clot burden in tandem strokes accounts for poor mechanical thrombectomy (MT) outcomes. Several studies have shown benefit of balloon guide catheters (BGC) in MT and carotid artery stenting. Given this potential benefit, we investigated safety and effectiveness of proximal flow arrest using BGC during concurrent MT and carotid revascularization for tandem stroke treatment in a comparative, propensity score-matched (PSM) study.
Materials and Methods Tandem stroke patients 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.
Results Concurrent carotid revascularization (stenting with/without angioplasty) and MT was performed in 125 cases (BGC:85;no BGC:40). After PSM (40 patients/group), BGC group had a significantly shorter procedure duration (77.9vs.61.5min;odds ratio[OR]=0.996;P=0.006), lower discharge National Institutes of Health Stroke Scale score (8.0vs.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, BGC group had a significantly higher first-pass effect rate (mTICI:2B-3)(OR=1.115,95%confidence interval[CI]=1.015-1.432;P=0.013) and lower periprocedural sICH rate (OR=0.615;95%CI=0.406-0.932;P=0.025) (table 1). No difference in in-hospital mortality was observed (OR=1.591;95%CI=0.976-2.593;P=0.067).
Conclusion BGCs used for concurrent MT-carotid revascularization with flow arrest were safe and resulted in superior clinical and angiographic outcomes in tandem stroke patients.
Disclosures A. Baig: None. M. Waqas: None. R. Turner: None. C. Kuo: None. B. Donnelly: None. P. Lai: None. K. Raygor: None. M. Bouslama: None. J. Lim: None. J. Neumaier: None. J. Cappuzzo: None. J. Davies: 1; C; NIH NINDS, NSF SBIR. 2; C; Medtronic; Honoraria. 4; C; Synchron, Cerebrotech, QAS.ai, RIST. K. Snyder: 2; C; Boston Scientific, Canon Medical Systems USA, Inc., MicroVention, Medtronic, Stryker Neurovascular. 4; C; Boston Scientific, Access Closure Inc, Niagara Gorge Medical. A. Siddiqui: 2; C; Amnis Therapeutics, Apellis Pharmaceuticals, Inc., Boston Scientific, Canon Medical Systems USA, Inc., Cardinal Health 200, LLC, and others. 4; C; Adona Medical, Inc., Amnis Therapeutics, Bend IT Technologies, Ltd., BlinkTBI, Inc, Buffalo Technology Partners, Inc., Cardinal Consultants, LLC, Cerebrotech Medical Systems, Inc, and others. 6; C; National PI/Steering Committees: Cerenovus EXCELLENT and ARISE II Trial; Medtronic SWIFT PRIME, VANTAGE, EMBOLISE and SWIFT DIRECT Trials; MicroVention FRED Trial & CONFIDENCE Study; and others. E. Levy: 2; C; Claret Medical, GLG Consulting, Guidepoint Global, Imperial Care, Medtronic, Rebound, StimMed, Misionix, Mosiac, and others. 4; C; NeXtGen Biologics, RAPID Medical, Claret Medical, Cognition Medical, Imperative Care, Rebound Therapeutics, StimMed, and others.
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