Balloon-guided catheters are associated with worse outcomes in large vessel thrombectomy

1. Functional recovery at 90 days was lower in the balloon-guided catheter group versus the conventional catheter group.

2. All-cause mortality was numerically greater in the balloon-guided catheter group, although this was not statistically significant.

Evidence Rating Level: 1 (Excellent)

Study Rundown: The use of balloon guide catheters during endovascular thrombectomy for acute ischemic stroke caused by large vessel occlusion remains controversial. Conventional guide catheters are commonly used, but their benefits have not been fully established. This randomized controlled trial aimed to evaluate the safety and efficacy of balloon-guided catheters versus conventional guide catheters in improving functional outcomes among patients undergoing endovascular thrombectomy. The primary outcome was functional recovery at 90 days, based on the modified Rankin Scale (mRS), while the key secondary outcome was all-cause mortality. According to study results, balloon-guided catheters were associated with worse functional outcomes compared to conventional catheters. Although this study was well done, it may have been limited by differences in operator technique with the balloon-guided catheter compared to the conventional catheter.

Click to read the study in The Lancet

Relevant Reading: Trial of Endovascular Thrombectomy for Large Ischemic Strokes

In-depth [randomized controlled trial]: Between Feb 7 and Nov 13, 2023, 1698 patients were assessed for eligibility across 28 hospitals in China. Included were patients ≥ 18 years with large-vessel ischemic stroke who were eligible for thrombectomy within 24 hours of symptom onset. Altogether, 329 patients (164 to balloon-guided catheter and 165 to conventional guide catheter) were included in the final analysis. The primary outcome of functional recovery showed significantly worse outcomes in the balloon-guided catheter group compared to the conventional catheter group (adjusted odds ratio 0.66, 95% confidence interval [CI] 0.45-0.98, p=0.037). The secondary outcome of all-cause mortality at 90 days was higher in the balloon-guided catheter versus conventional catheter group (24% vs. 16%) but not statistically significant. Findings from this study suggest that balloon-guided catheters are associated with worse functional outcomes in large vessel thrombectomy.

Image: PD

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