Introduction: The efficacy of balloon-guide catheters (BGC) for mechanical thrombectomy (MT) in acute ischemic stroke (AIS) remains contentious, with reports showing both improved and worsened outcomes. We present a retrospective analysis from a high-volume comprehensive stroke center comparing BGCs to standard guide sheaths (GS) to clarify their impact on AIS treatment.
Methods: We retrospectively reviewed all patients who underwent MT for AIS due to anterior circulation large-vessel occlusion (LVO) from 2005 to 2023. Inclusion criteria were age >18 with an occlusion of the ICA terminus, M1, or M2 segment of the middle cerebral artery. Procedural decisions were made by the attending neurointerventionalist across six operators. Patients with missing procedural data were excluded. Demographics, clinical details, 90-day outcomes, and equipment use were extracted from charts. A matched-pair analysis controlled for confounders, including age, occlusion location, onset-to-angiogram time, IV thrombolytics, NIHSS at admission, and baseline antiplatelet use. Primary outcomes included modified first-pass effect (mFPE; mTICI ≥2c on the first pass), excellent final reperfusion (mTICI ≥2c), and 90-day mRS. Secondary outcomes included access-to-reperfusion time, access-to-first deployment time, and NIHSS shift (change from presentation to discharge). Subgroup analyses compared proximal (ICA/M1) vs. distal (M2) LVOs without matching. Multiple linear regression with nearest-neighbor matching controlled for confounding. Log-transformed regression models addressed skewed time-based variables. Analyses were conducted in R.
Results: Of 3,587 screened patients, 3,348 were included (BGC-MT: 786 [23%], GS-MT: 2,562 [77%]). BGC use increased mFPE rates by 9.1% (p < 0.001) and improved 90-day outcomes (mRS reduction: -0.27, p = 0.032). BGC-treated patients showed greater early neurological recovery (NIHSS shift: -1.39, p < 0.001). Procedural efficiency improved with 20.3% shorter recanalization times (p < 0.001) and 18.0% shorter puncture-to-first deployment times (p < 0.001), indicating faster reperfusion and device deployment.
Conclusion : BGC-MT is associated with improved mFPE, better short and long-term neurological outcomes, as well as faster procedure time relative to GS-MT. A randomized controlled trial of BGC-MT is warranted.
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