Having been launched earlier this year, the Emboguard balloon guide catheter (Cerenovus) was recently used in mechanical thrombectomy procedures for the first time. David Fiorella (Stony Brook University Hospital, New York, USA), who performed these milestone stroke treatments, speaks to NeuroNews to discuss the device and the wider implications it may hold for the neurovascular space.
Could you briefly describe the recent first thrombectomy procedure(s) with the Emboguard balloon guide catheter?
As the first physician to use the Emboguard balloon guide catheter during a mechanical thrombectomy procedure to treat an ischaemic stroke, I was impressed by the device trackability and how easily it integrated into my setup. We were able to get first pass mTICI [modified thrombolysis in cerebral infarction] 3 for the patient, in combination with other devices, and the patient recovered well post-case. Overall, I have been pleased with the device performance during and since this first case.
Why did you select the Emboguard specifically for this first case?
I had extensively tested Emboguard in the neurovascular replicator Asist stroke system (Mentice) prior to this first case. It demonstrated excellent trackability and ease of use in the Mentice replicator—even in a variety of very challenging vascular anatomies. The Emboguard device performed similarly well in my first clinical cases. My preclinical and initial clinical impression indicates that Emboguard certainly belongs in the league of these markedly improved, next-generation balloon guide catheters.
What is your experience of using the device to date—from your perspective as a physician, what are the advantages it offers?
My experience using the device has been positive in terms of ease of use, trackability and overall performance thus far.
What benefits does it offer for the patient?
While a randomised controlled trial of balloon guide versus no balloon guide would provide definitive clinical evidence, the available data give a strong signal to indicate that the use of a balloon guide catheter likely improves first-pass recanalisation and patient outcomes in thrombectomy. The Emboguard device is in the category of next-generation balloon guide catheters, which are substantially more navigable and stable than their predecessors. I believe that this new catheter technology will represent a substantial advance for interventional stroke therapy.
Do you think it holds the potential to be used in other case and procedure types in the future?
The Emboguard balloon guide catheter is currently indicated for use in angiographic procedures, including acute ischaemic stroke as well as carotid and venous stenting.
What impact do you think technologies like Emboguard are having, or will have, on the neurovascular space?
The benefit of new technologies like Emboguard and others is to improve patient outcomes and treatment during cases. As stated, the existing evidence points to a substantial benefit for the use of balloon guide catheters and the industry has continued to advance these devices—and overall innovation in the neurovascular space—in the interest of improving patient care.
What does the future hold for this device?
My experience with the Emboguard balloon guide catheter has been positive. I will continue to integrate these next-generation balloon guide catheters into my clinical practice, as appropriate, in ischaemic stroke and endovascular intervention cases. I am a strong believer in the benefits of balloon guide catheters like Emboguard to optimise patient outcomes, so I anticipate we will see more physicians beginning to use this device now that it is available as a part of Cerenovus’ stroke solutions portfolio.
David Fiorella is the director of the Cerebrovascular and Vascular Centers, co-director of the Comprehensive Stroke Center, and a professor in the Department of Neurosurgery, in the Renaissance School of Medicine at Stony Brook University in New York, USA. He is also the principal investigator or co-principal investigator on numerous national trials evaluating new devices and techniques for the treatment of aneurysms, acute stroke and intracerebral haemorrhage in the USA.
DISCLOSURES: Fiorella is a consultant of Cerenovus, part of Johnson & Johnson MedTech.