Impact of balloon guiding catheter in contact aspiration thrombectomy using large bore aspiration catheter for acute anterior circulation stroke patients: a case-control study

BACKGROUND: Balloon guiding catheters (BGCs) have been shown to reduce distal embolization during mechanical thrombectomy with stent retrievers, but their benefit in contact aspiration thrombectomy (CAT) is not well established. We aimed to evaluate the impact of BGC use during CAT with large-bore aspiration catheters in acute anterior circulation large-vessel occlusion (LVO) stroke. METHODS: We retrospectively reviewed acute ischemic stroke patients with anterior circulation LVO treated with first-line CAT at two tertiary hospitals. Patients were grouped by whether a BGC was used. The predefined primary outcome was first-pass successful reperfusion, defined as achieving mTICI 2b–3 with a single thrombectomy device pass. Baseline characteristics, angiographic outcomes, and clinical outcomes were compared between groups. Subgroup analysis was performed for internal carotid artery (ICA)-involved versus isolated middle cerebral artery (MCA) occlusions. RESULTS: A total of 172 patients were included (101 with BGC, 71 without). The BGC group achieved a higher rate of complete reperfusion (mTICI 3: 60.4% vs. 47.9%, P = 0.047) and first-pass successful reperfusion (63.4% vs. 46.5%, P = 0.045) compared to the non-BGC group. BGC use was associated with shorter procedure time (median 51 vs. 65 min, P = 0.023) and less frequent need for device switching (26.7% vs. 46.5%, P = 0.007). At 3 months, favourable functional outcome (mRS 0–2) was more frequent with BGC (50.5% vs. 36.62%), although this difference did not reach statistical significance (P = 0.071). There were no significant differences in 90-day mortality or symptomatic intracranial hemorrhage between the groups. In patients with ICA-involving occlusions, BGC use yielded significantly higher rates of favorable outcome (50.8% vs. 30.0%, P = 0.030) and first-pass complete reperfusion (59.3% vs. 30.0%, P = 0.010) compared to no BGC. In contrast, outcomes in MCA-only occlusions were similar with or without BGC. CONCLUSIONS: The use of a BGC during CAT for anterior circulation stroke was associated with improved reperfusion success and more efficient procedures. BGCs may enhance first-pass recanalization and possibly functional outcomes, particularly in ICA terminus occlusions, without increasing adverse events. These findings support the incorporation of BGCs as a valuable adjunct to CAT in appropriate patients.