Clinical and Procedural Outcomes with or without Balloon Guide Catheters during Endovascular Thrombectomy in Acute Ischemic Stroke: A Systematic Review and Meta-analysis with First-line Technique Subgroup Analysis

TY - JOUR

T1 - Clinical and Procedural Outcomes with or without Balloon Guide Catheters during Endovascular Thrombectomy in Acute Ischemic Stroke

T2 - A Systematic Review and Meta-analysis with First-line Technique Subgroup Analysis

AU - Podlasek, Anna

AU - Dhillon, P. S.

AU - Jewett, G.

AU - Shahein, A.

AU - Goyal, M.

AU - Almekhlafi, M.

N1 - Copyright: © 2021 American Society of Neuroradiology. All rights reserved.

PY - 2021/8

Y1 - 2021/8

N2 - Background: Balloon guide catheters are increasingly used to improve clot retrieval by temporarily stopping proximal blood flow during endovascular thrombectomy. Purpose: Our aim was to provide a summary of the literature comparing the procedural and clinical outcomes of endovascular thrombectomy with or without balloon guide catheters, depending on the first-line technique used. Data Sources: We used PubMed/MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews. Study Selection: We chose studies that compared using balloon guide catheters with not using them. Data Analysis: Random effects meta-analysis was performed to compare the procedural outcomes measured as the first-pass effect, successful reperfusion, number of passes, procedural duration, arterial puncture to reperfusion time, distal emboli, and clinical outcomes. Data Synthesis: Overall, a meta-analysis of 16 studies (5507 patients, 50.8% treated with balloon guide catheters and 49.2% without them) shows that the use of balloon guide catheters increases the odds of achieving a first-pass effect (OR = 1.92; 95% CI, 1.34-2.76; P,.001), successful reperfusion (OR = 1.85; 95% CI, 1.42-2.40; P,.001), and good functional outcome (OR = 1.48; 95% CI, 1.27-1.73; P,.001). Balloon guide catheters reduce the number of passes (mean difference = -0.35; 95% CI, -0.65 to -0.04; P =.02), procedural time (mean difference = -19.73; 95% CI, -34.63 to -4.83; P =.009), incidence of distal or new territory emboli (OR = 0.5; 95% CI, 0.26-0.98; P =.04), and mortality (OR = 0.72; 95% CI, 0.62-0.85; P,.001). Similar benefits of balloon guide catheters are observed when the first-line technique was a stent retriever or contact aspiration, but not for a combined approach. LIMITATIONS: The analysis was based on nonrandomized trials with a moderate risk of bias.Conclusions: Current literature suggests improved clinical and procedural outcomes associated with the use of balloon guide catheters during endovascular thrombectomy, especially when using the first-line stent retriever.

AB - Background: Balloon guide catheters are increasingly used to improve clot retrieval by temporarily stopping proximal blood flow during endovascular thrombectomy. Purpose: Our aim was to provide a summary of the literature comparing the procedural and clinical outcomes of endovascular thrombectomy with or without balloon guide catheters, depending on the first-line technique used. Data Sources: We used PubMed/MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews. Study Selection: We chose studies that compared using balloon guide catheters with not using them. Data Analysis: Random effects meta-analysis was performed to compare the procedural outcomes measured as the first-pass effect, successful reperfusion, number of passes, procedural duration, arterial puncture to reperfusion time, distal emboli, and clinical outcomes. Data Synthesis: Overall, a meta-analysis of 16 studies (5507 patients, 50.8% treated with balloon guide catheters and 49.2% without them) shows that the use of balloon guide catheters increases the odds of achieving a first-pass effect (OR = 1.92; 95% CI, 1.34-2.76; P,.001), successful reperfusion (OR = 1.85; 95% CI, 1.42-2.40; P,.001), and good functional outcome (OR = 1.48; 95% CI, 1.27-1.73; P,.001). Balloon guide catheters reduce the number of passes (mean difference = -0.35; 95% CI, -0.65 to -0.04; P =.02), procedural time (mean difference = -19.73; 95% CI, -34.63 to -4.83; P =.009), incidence of distal or new territory emboli (OR = 0.5; 95% CI, 0.26-0.98; P =.04), and mortality (OR = 0.72; 95% CI, 0.62-0.85; P,.001). Similar benefits of balloon guide catheters are observed when the first-line technique was a stent retriever or contact aspiration, but not for a combined approach. LIMITATIONS: The analysis was based on nonrandomized trials with a moderate risk of bias.Conclusions: Current literature suggests improved clinical and procedural outcomes associated with the use of balloon guide catheters during endovascular thrombectomy, especially when using the first-line stent retriever.

UR - https://www.scopus.com/pages/publications/85112780870

U2 - 10.3174/ajnr.A7164

DO - 10.3174/ajnr.A7164

M3 - Review article

C2 - 34045301

AN - SCOPUS:85112780870

SN - 0195-6108

VL - 42

SP - 1464

EP - 1471

JO - American Journal of Neuroradiology

JF - American Journal of Neuroradiology

IS - 8

ER -