Background Balloon guide catheters (BGC) are commonly used as the primary tool to achieve flow arrest in endovascular thrombectomies and, by doing so, reducing the risk of clot fragmentation and improving the degree and frequency of recanalization. Prior research shows that aspiration catheters sized to closely match the target vessel may lead to more successful recanalization outcomes. Furthermore, distal intracranial positioning of the Zoom™ 88 guide catheters has been associated with better reperfusion success. The aim of this study was to assess the safety, efficacy, and procedural attributes of BGC compared to the current generation of large-bore guide catheters within a single-center setting.

Methods We conducted a retrospective review of a prospectively maintained Institutional Review Board approved database. We selected consecutive cases in which the Zoom™ 88 guide catheter was utilized to provide access for thrombectomy procedures following its introduction at our institution (Zoom group). These cases were then compared to consecutive cases where BGC were employed before the introduction of the Zoom™ catheters (BGC group) at our center. All procedures were performed by a single operator at an academic center. Outcomes of interest included the degree of final reperfusion (mTICI score), time from groin puncture to recanalization, first pass effect (mTICI ≥2B), post-procedural complications, and all-cause mortality at 90-days.

Results Forty-seven consecutive patients with large vessel occlusion who underwent endovascular thrombectomies were included in the study cohort. Among them, twenty-seven underwent procedures with BGC and the remaining 20 procedures used Zoom™ 088 guide catheters. There were significantly more M1 occlusions in the Zoom group (table 1). All patients in the study achieved a self-adjudicated ≥mTICI 2b; a nominal improvement favored the Zoom group to achieve mTICI 3 (50% vs 29.6%, p=0.226). The Solumbra technique was less frequently employed in the Zoom group (10%; 2/20 vs. 48.1%; 13/27 in the BGC group, p=0.01). The median time from groin puncture to procedure completion was significantly shorter in the Zoom group compared to the BGC group, at 21 minutes versus 41 minutes, respectively. First pass effect was achieved more frequently in the Zoom group, with 80% (16/20) of cases compared to 48.1% (13/27) in the BGC group, p=0.036. No device or procedure-related clinical complications were observed in either group. All-cause mortality rates were similar between the two groups (table 1).

Conclusion In our study, the utilization of Zoom™ 88 guide catheters, as compared to BGC, resulted in significantly shorter time to reperfusion, a notably improved first-pass effect, and a significant reduction in the need for the Solumbra technique, all without any observed safety concerns.

Disclosures A. Trang: None. J. Marino: None. J. Cherian: None.