Impact of Balloon Guide Catheter Use on Clinical and Angiographic Outcomes in the STRATIS Stroke Thrombectomy Registry
Authors: Zaidat Osama O. , Mueller-Kronast Nils H. , Hassan Ameer E. , Haussen Diogo C. , Jadhav Ashutosh P. , Froehler Michael T. , Jahan Reza , Ali Aziz-Sultan Mohammad , Klucznik Richard P. , Saver Jeffrey L. , Hellinger Frank R. , Yavagal Dileep R. , Yao Tom L. , Gupta Rishi , Martin Coleman O. , Bozorgchami Hormozd , Kaushal Ritesh , Nogueira Raul G. , Gandhi Ravi H. , Peterson Eric C. , Dashti Shervin , Given Curtis A. , Mehta Brijesh P. , Deshmukh Vivek , Starkman Sidney , Linfante Italo , McPherson Scott H. , Kvamme Peter , Grobelny Thomas J. , Hussain Muhammad Shazam , Thacker Ike , Vora Nirav , Chen Peng Roc , Monteith Stephen J. , Ecker Robert D. , Schirmer Clemens M. , Sauvageau Eric , Chebl Alex Bou , Derdeyn Colin P. , Maidan Lucian , Badruddin Aamir , Siddiqui Adnan H. , Dumont Travis M. , Alhajeri Abdulnasser , Taqi Muhammad A. , Asi Khaled , Carpenter Jeffrey , Boulos Alan , Jindal Gaurav , Puri Ajit S. , Chitale Rohan , Deshaies Eric M. , Robinson David , Kallmes David F. , Baxter Blaise W. , Jumaa Mouhammed , Sunenshine Peter , Majjhoo Aniel , English Joey D. , Suzuki Shuichi , Fessler Richard D. , Delgado-Almandoz Josser , Martin Jerry C. , Liebeskind David S. ,   on behalf of the STRATIS Investigators
Published: February 2019

Background and Purpose—
Mechanical thrombectomy has been shown to improve clinical outcomes in patients with acute ischemic stroke. However, the impact of balloon guide catheter (BGC) use is not well established.

Methods—
STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) was a prospective, multicenter study of patients with large vessel occlusion treated with the Solitaire stent retriever as first-line therapy. In this study, an independent core laboratory, blinded to the clinical outcomes, reviewed all procedures and angiographic data to classify procedural technique, target clot location, recanalization after each pass, and determine the number of stent retriever passes. The primary clinical end point was functional independence (modified Rankin Scale, 0–2) at 3 months as determined on-site, and the angiographic end point was first-pass effect (FPE) success rate from a single device attempt (modified Thrombolysis in Cerebral Infarction, ≥2c) as determined by a core laboratory. Achieving modified FPE (modified Thrombolysis in Cerebral Infarction, ≥2b) was also assessed. Comparisons of clinical outcomes were made between groups and adjusted for baseline and procedural characteristics. All participating centers received institutional review board approval from their respective institutions.

Results—

Adjunctive technique groups included BGC (n=445), distal access catheter (n=238), and conventional guide catheter (n=62). The BGC group had a higher rate of FPE following first pass (212/443 [48%]) versus conventional guide catheter (16/62 [26%];
P
=0.001) and distal access catheter (83/235 [35%];
P
=0.002). Similarly, the BGC group had a higher rate of modified FPE (294/443 [66%]) versus conventional guide catheter (26/62 [42%];
P
<0.001) and distal access catheter (129/234 [55%];
P
=0.003). The BGC group achieved the highest rate of functional independence (253/415 [61%]) versus conventional guide catheter (23/55 [42%];
P
=0.007) and distal access catheter (113/218 [52%];
P
=0.027). Final revascularization and mortality rates did not differ across the groups.

Conclusions—
BGC use was an independent predictor of FPE, modified FPE, and functional independence, suggesting that its routine use may improve the rates of early revascularization success and good clinical outcomes.

Clinical Trial Registration—

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02239640.