Angiographic and clinical outcomes following endovascular thrombectomy for anterior circulation ischemic stroke: impact of balloon guide catheter utilization

BACKGROUND: Previous studies favoring the use of balloon guide catheters (BGCs) during endovascular thrombectomy for anterior circulation acute ischemic stroke either predate advancements in catheter technology or inadequately adjust for large-bore aspiration catheters. This study compared angiographic and clinical outcomes for stroke thrombectomy performed without and with BGCs. METHODS: This multicenter, retrospective study analyzed matched anterior circulation thrombectomy cases performed between February 2018 and February 2024. BGC and non-BGC cases were 1:1 matched by demographic and clinical variables. Primary outcome measures were successful reperfusion (modified thrombolysis in cerebral infarction ≥2B) and good clinical outcome (modified Rankin Scale score 0-2 at discharge and 30 days). RESULTS: Among 407 patients (non-BGC=199, BGC=208), BGC use had higher rates of successful reperfusion (83.9% vs 90.9%, P=0.034) and better functional outcomes at discharge (18.7% vs 28.4%, P=0.022) and 30 days (21.1% vs 31.3%, P=0.020). On multivariable analysis, BGC independently predicted successful reperfusion (OR 2.29, 95% CI 1.56 to 3.77, P=0.02) and good outcomes at discharge (OR 1.87, 95% CI 1.14 to 3.07, P=0.01) and 30 days (OR 1.89, 95% CI 1.18 to 3.03, P=0.01). Subgroup analysis demonstrated that BGC use was most beneficial in patients with times from last known well to puncture ≤6 hours, with higher rates of successful reperfusion (84.5% vs 94.6%, P=0.041) and favorable outcomes at discharge (14.5% vs 32.4%, P=0.007) and 30 days (23.8% vs 39.2%, P=0.037). CONCLUSION: BGC use during endovascular thrombectomy is associated with higher rates of successful reperfusion and better early functional outcomes, particularly in patients treated within 6 hours of last-known-well time.