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Effect of balloon guide catheter utilization on contact aspiration thrombectomy

 Dong-Hun Kang  ;  Byung Moon Kim  ;  Ji Hoe Heo  ;  Hyo Suk Nam  ;  Young Dae Kim  ;  Yang-Ha Hwang  ;  Yong-Won Kim  ;  Yong-Sun Kim  ;  Dong Joon Kim  ;  Hyo Sung Kwak  ;  Hong Gee Roh  ;  Young-Jun Lee  ;  Sang Heum Kim 
 JOURNAL OF NEUROSURGERY, Vol.131(5) : 1494-1500, 2019 
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ASPECTS = Alberta Stroke Program Early CT Score ; BGC = balloon guide catheter ; CAT = contact aspiration thrombectomy ; CRF = case report form ; EVT = endovascular thrombectomy ; ICA = internal carotid artery ; LVO = large vessel occlusion ; MCA = middle cerebral artery ; NIHSS = National Institutes of Health Stroke Scale ; OPT = onset-to-puncture time ; PRT = puncture-to-recanalization time ; RCT = randomized controlled trial ; acute stroke ; aspiration catheter ; balloon guide catheter ; interventional neurosurgery ; mRS = modified Rankin Scale ; mTICI modified Thrombolysis in Cerebral Infarction ; tPA = tissue plasminogen activator ; thrombectomy ; vascular disorders
OBJECTIVEThe role of the balloon guide catheter (BGC) has not been evaluated in contact aspiration thrombectomy (CAT) for acute stroke. Here, the authors aimed to test whether the BGC was associated with recanalization success and good functional outcome in CAT.METHODSAll patients who had undergone CAT as the first-line treatment for anterior circulation intracranial large vessel occlusion were retrospectively identified from prospectively maintained registries for six stroke centers. The patients were dichotomized into BGC utilization and nonutilization groups. Clinical findings, procedural details, and recanalization success rates were compared between the two groups. Whether the BGC was associated with recanalization success and functional outcome was assessed.RESULTSA total of 429 patients (mean age 68.4 ± 11.4 years; M/F ratio 215:214) fulfilled the inclusion criteria. A BGC was used in 45.2% of patients. The overall recanalization and good outcome rates were 80.2% and 52.0%, respectively. Compared to the non-BGC group, the BGC group had a significantly reduced number of CAT passes (2.6 ± 1.6 vs 3.4 ± 1.5), shorter puncture-to-recanalization time (56 ± 27 vs 64 ± 35 minutes), lower need for the additional use of thrombolytics (1.0% vs 8.1%), and less embolization to a distal or different site (0.5% vs 3.4%). The BGC group showed significantly higher final (89.2% vs 72.8%) and first-pass (24.2% vs 8.1%) recanalization success rates. After adjustment for potentially associated factors, BGC utilization remained independently associated with recanalization (OR 4.171, 95% CI 1.523-11.420) and good functional outcome (OR 2.103, 95% CI 1.225-3.612).CONCLUSIONSBGC utilization significantly increased the final and first-pass recanalization rates and remained independently associated with recanalization success and good functional outcome.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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