Balloon Guide Catheter Use and Outcomes After Endovascular Thrombectomy for Ischemic Stroke Due to Large Vessel Occlusions
Hansen, Björn M LU
; Hall, Emma
LU
; Szolics, Alex
; Andersson, Tommy
and Wassélius, Johan
LU
(2025)
In Clinical Neuroradiology
- Abstract
BACKGROUND: Balloon-guide catheters (BGC) have been associated with improved procedural and functional outcomes following endovascular thrombectomy (EVT) in multiple observational studies. Recently the PROTECT-MT trial challenged this benefit, showing worse functional outcomes when using BGCs. This study aims to assess the association between BGC-use and procedural and functional outcomes in a large real-world cohort.
METHODS: Patients who underwent EVT for anterior circulation large vessel occlusion (LVO) between 2017 and 2021 were included in two Swedish registries: EVAS and Riksstroke. Outcomes included recanalization success (modified Treatment In Cerebral Infarction [mTICI] 2b/2c-3), good 90-day functional outcome (modified... (More)
BACKGROUND: Balloon-guide catheters (BGC) have been associated with improved procedural and functional outcomes following endovascular thrombectomy (EVT) in multiple observational studies. Recently the PROTECT-MT trial challenged this benefit, showing worse functional outcomes when using BGCs. This study aims to assess the association between BGC-use and procedural and functional outcomes in a large real-world cohort.
METHODS: Patients who underwent EVT for anterior circulation large vessel occlusion (LVO) between 2017 and 2021 were included in two Swedish registries: EVAS and Riksstroke. Outcomes included recanalization success (modified Treatment In Cerebral Infarction [mTICI] 2b/2c-3), good 90-day functional outcome (modified Rankin Scale score 0-2), and safety outcomes (iatrogenic dissection, perioperative embolization, early neurological deterioration, and 90-day mortality). Subgroup analysis was conducted by first-line EVT strategy: stent-retriever (with/without aspiration) or contact aspiration alone.
RESULTS: Of 4843 patients, 2483 met the inclusion criteria. BGCs were used in 1449 cases (58.4%) and were more frequently used with stent-retrievers (83.0%) than with contact aspiration (24.1%, p < 0.001). BGC-use was associated with higher rates of excellent recanalization (mTICI 2c-3) and first-pass success, particularly in stent-retriever cases (p < 0.001), but not with good recanalization (mTICI 2b-3). No association was found with good 90-day functional outcome or any safety outcome (p > 0.05). A numerically lower mortality rate was observed with BGCs (19.0% vs. 22.9%, p = 0.019), although this was not significant after adjustment.
CONCLUSIONS: BGC-use during EVT was associated with excellent recanalization and first-pass reperfusion, primarily in stent-retriever-treated patients. No significant impact on 90-day functional outcome nor on safety indicators was observed.
(Less)
- author
- Hansen, Björn M
LU
; Hall, Emma
LU
; Szolics, Alex
; Andersson, Tommy
and Wassélius, Johan
LU
- organization
- publishing date
- 2025-09-22
- type
- Contribution to journal
- publication status
- epub
- subject
- keywords
- stroke, device, reperfusion, technique, thrombectomy
- in
- Clinical Neuroradiology
- pages
- 7 pages
- publisher
- Springer Science and Business Media B.V.
- external identifiers
-
- pmid:40983747
- scopus:105016799352
- ISSN
- 1869-1439
- DOI
- 10.1007/s00062-025-01570-z
- language
- English
- LU publication?
- yes
- additional info
- © 2025. The Author(s).
- id
- 6a7d65e3-cc35-488d-a2bf-11dd53a4708d
- date added to LUP
- 2025-09-25 09:23:39
- date last changed
- 2025-10-22 05:39:54
@article{6a7d65e3-cc35-488d-a2bf-11dd53a4708d,
abstract = {{<p>BACKGROUND: Balloon-guide catheters (BGC) have been associated with improved procedural and functional outcomes following endovascular thrombectomy (EVT) in multiple observational studies. Recently the PROTECT-MT trial challenged this benefit, showing worse functional outcomes when using BGCs. This study aims to assess the association between BGC-use and procedural and functional outcomes in a large real-world cohort.</p><p>METHODS: Patients who underwent EVT for anterior circulation large vessel occlusion (LVO) between 2017 and 2021 were included in two Swedish registries: EVAS and Riksstroke. Outcomes included recanalization success (modified Treatment In Cerebral Infarction [mTICI] 2b/2c-3), good 90-day functional outcome (modified Rankin Scale score 0-2), and safety outcomes (iatrogenic dissection, perioperative embolization, early neurological deterioration, and 90-day mortality). Subgroup analysis was conducted by first-line EVT strategy: stent-retriever (with/without aspiration) or contact aspiration alone.</p><p>RESULTS: Of 4843 patients, 2483 met the inclusion criteria. BGCs were used in 1449 cases (58.4%) and were more frequently used with stent-retrievers (83.0%) than with contact aspiration (24.1%, p < 0.001). BGC-use was associated with higher rates of excellent recanalization (mTICI 2c-3) and first-pass success, particularly in stent-retriever cases (p < 0.001), but not with good recanalization (mTICI 2b-3). No association was found with good 90-day functional outcome or any safety outcome (p > 0.05). A numerically lower mortality rate was observed with BGCs (19.0% vs. 22.9%, p = 0.019), although this was not significant after adjustment.</p><p>CONCLUSIONS: BGC-use during EVT was associated with excellent recanalization and first-pass reperfusion, primarily in stent-retriever-treated patients. No significant impact on 90-day functional outcome nor on safety indicators was observed.</p>}},
author = {{Hansen, Björn M and Hall, Emma and Szolics, Alex and Andersson, Tommy and Wassélius, Johan}},
issn = {{1869-1439}},
keywords = {{stroke; device; reperfusion; technique; thrombectomy}},
language = {{eng}},
month = {{09}},
publisher = {{Springer Science and Business Media B.V.}},
series = {{Clinical Neuroradiology}},
title = {{Balloon Guide Catheter Use and Outcomes After Endovascular Thrombectomy for Ischemic Stroke Due to Large Vessel Occlusions}},
url = {{http://dx.doi.org/10.1007/s00062-025-01570-z}},
doi = {{10.1007/s00062-025-01570-z}},
year = {{2025}},
}