Impact of Balloon Guide Catheter on Thrombectomy Outcomes in Intracranial Carotid Artery Embolic Occlusion: A Retrospective Cohort Study
Jinfeng Miao, Hanrong Dong, Yanmin Wu, Ding-lai Lin, Xiao-hui Lin, Zhinan Pan, Li-san Zeng, Wenhuo Chen, Tingyu YiBACKGROUND:
The balloon guide catheter (BGC) is widely used in endovascular thrombectomy, but evidence of its effect in intracranial internal carotid artery embolic occlusion is limited, and recent randomized trials have reported contradictory outcomes. We aimed to explore the potential association between BGC use and outcomes of thrombectomy in intracranial internal carotid artery embolic occlusion.
METHODS:
Patients with acute intracranial internal carotid artery occlusion from a prospectively maintained 2-center stroke registry were classified according to BGC use. Propensity score matching and overlap weighting were used to balance baseline differences. The primary outcome was functional independence at 90 days (modified Rankin Scale score, 0–2). Secondary outcomes included first-pass complete reperfusion (expanded Thrombolysis in Cerebral Infarction grade 3), distal emboli, and 90-day modified Rankin Scale score shift.
RESULTS:
Among 397 patients (median age, 72 years; 45.1% men), 90 (22.7%) underwent BGC-assisted endovascular thrombectomy. After 1:2 propensity score matching (84 BGC versus 168 non-BGC), the groups were well balanced. BGC use was associated with higher odds of 90-day functional independence (propensity score matching odds ratio [OR], 2.24 [95% CI, 1.07–4.72]; overlap weighting OR, 1.97 [95% CI, 1.07–3.62]), higher rates of first-pass expanded Thrombolysis in Cerebral Infarction 3 reperfusion (propensity score matching OR, 1.98 [95% CI, 1.09–3.60]; overlap weighting OR, 1.74 [95% CI, 1.05–2.89]), and fewer distal emboli (overlap weighting OR, 0.49 [95% CI, 0.25–0.97]). The 90-day modified Rankin Scale score distribution favored BGC use, but was not statistically significant (
CONCLUSIONS:
In acute intracranial internal carotid artery embolic occlusion, BGC use was associated with better functional outcomes, higher first-pass reperfusion rates, and fewer distal emboli. These findings suggest that BGC may be a beneficial adjunct in this population and warrant validation in prospective trials.