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Following the recent addition of the EMBOGUARD balloon guide catheter (BGC) to the CERENOVUS STROKE SOLUTIONSi portfolio of devices, Demetrius K Lopes (Chicago, USA) discusses the significance of this latest tool when it comes to treating patients—offering his personal opinions and findings, experiences and perspective, as well as what these developments could mean for the future.
The brain controls our movements, holds our memories, and is the origin of our thoughts, emotions and language. But when an ischaemic stroke occurs, blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Invaluable brain cells die within minutes.
This neurovascular disease is not only harmful but, unfortunately, common. Ischaemic stroke accounts for 85% of all strokes1 and, globally, one in four adults over the age of 25 will have a stroke in their lifetime.2 The impact of stroke can be short or long term, depending on which part of the brain is affected and how quickly it is treated. However, advancements in stroke research over the last decade have led to innovative and effective treatments, like mechanical thrombectomy, which is a minimally invasive procedure3 that offers positive benefits for patients after an ischaemic stroke—if applied in the first few hours after stroke onset.
The overall goal of thrombectomy procedures is to achieve a high first-pass recanalisation rate, which is defined as a complete or near-complete recanalisation (restoration of blood flow) with a single thrombectomy attempt.4 First-pass recanalisation is the procedural goal for the treatment of ischaemic stroke, as it helps patients experience the greatest benefits5 and may also be considered as a benchmark to measure the angiographic efficacy for thrombectomy devices.4
Importance of innovative, compatible thrombectomy solutions
As the director of Cerebrovascular Surgery and the Comprehensive Stroke Program surgical director at Advocate Health—a health system that includes five comprehensive stroke centres—I have insight into vast procedural outcomes across the country. Across our system, strokes present within different age groups and patient populations, and with varying sets of difficulties. With so many variables, it is critically important that we choose the right tools to cover the full range of stroke situations—like the CERENOVUS STROKE SOLUTIONS portfolio.
Often, acute stroke is not a problem with a single solution. It can be difficult to predict, and it is important to have tools that are easy to use for every level of training, from the most senior physician to new attending. The CERENOVUS STROKE SOLUTIONS portfolio consists of the EMBOTRAP III revascularisation device, CEREBASE DA guide sheath, CERENOVUS large bore catheter, PROWLER EX microcatheter and, most recently, the EMBOGUARD BGCi to create a comprehensive package of devices.
When you mix and match other devices, there are often discrepancies in compatibility, which can cause lab confusion and treatment challenges that could account for access issues, and even waste valuable time. When devices are comprehensively designed for compatibility and support ease of use, the physician and the lab team may be more comfortable, which can lead to more efficiency in the lab.
My experiences with a comprehensive portfolio of solutions
CERENOVUS STROKE SOLUTIONS has a plug-and-play approach to provide comprehensive usage that can address whatever problem I am presented with, especially with the latest addition of the EMBOGUARD BGC. In the past, BGCs have not been the easiest solution to use or handle, but EMBOGUARD has changed how we are able to approach mechanical thrombectomy procedures.
It has the features and trackability you would expect from a non-balloon guide catheter with the benefits of flow arrest—when inflated, the EMBOGUARD catheter can block blood flow in a controlled manner. BGCs can also result in significantly reduced distal emboli to both affected and previously unaffected territories.6 EMBOGUARD’s excellent balance of trackability and supportii allow me to distally place the device, and keep it there.
In my experience, its combined features have a positive impact on procedure quality and performance, and allow for variation in the procedure. I am able to perform procedures from thrombectomies, to carotid stenting, to tandem occlusions. Knowing I have the capabilities of a BGC available if needed provides peace of mind that I can be ready for any ischaemic stroke procedure that requires the use of a BGC.
Clinical evidence has shown that use of a BGC can improve first-pass recanalisation and certain patient outcome measures, including greater odds of a final thrombolysis in cerebral infarction (TICI) score of 3iii (49.1% BGC vs 37.3% non-BGC), better clinical outcomes at 90 daysiv (modified Rankin Scale [mRS] score; 54.5% BGC vs 43.7% non-BGC), shorter procedure time and less adjunctive (supplemental) therapy needed.7,8,9
What does the future hold?
It is becoming clear that innovative developments, like the EMBOGUARD catheter, that work in tandem with a portfolio of comprehensive and compatible solutionsi will continue to gain traction in the stroke space, as the results speak for themselves. It is particularly important that we dismiss any preconceived notions we may have about BGCs and remain open-minded when it comes to new developments and continued innovation of these next-generation devices. When treating stroke, we want the latest and most effective solutions in order to be successful in caring for our patients.
By embracing new innovations in stroke care and partnering with companies like CERENOVUS, who are making important impacts in the stroke space, you will see firsthand how industry is committed to driving strong outcomes for patients, therefore enabling better chances of recovery.
- “Ischaemic stroke”. Stroke Association. Stroke.org.uk. https://www.stroke.org.uk/what-is-stroke/types-of-stroke/ischaemic-stroke.
- “Learn About Stroke”. World Stroke Organization. World-stroke.org. https://www.world-stroke.org/world-stroke-day-campaign/why-stroke-matters/learn-about-stroke.
- “Mechanical Thrombectomy for Acute Stroke”. The Society of Vascular and Interventional Neurology (SVIN) and Mission Thrombectomy 2020+. 10 October 2020. https://www.svin.org/files/Final_formatted_SVIN_White_ paper_2020_updated_references(1).pdf.
- Zaidat O O, Ribo M, Mattle H P et al. Health economic impact of first-pass success among patients with acute ischemic stroke treated with mechanical thrombectomy: a United States and European perspective. J Neurointerv Surg. 2021; 13(12): 1117–23. DOI: 10.1136/neurintsurg-2020-016930.
- Jang K M, Choi H H, Nam T K et al. Clinical outcomes of first-pass effect after mechanical thrombectomy for acute ischemic stroke: A systematic review and meta-analysis. Clin Neurol Neurosurg. 2021; 211: 107030. DOI: 10.1016/j.clineuro.2021.107030.
- Chueh J Y, Kang D H, Kim B M et al. Role of Balloon Guide Catheter in Modern Endovascular Thrombectomy. J Korean Neurosurg Soc. 2020; 63(1): 14–25. DOI: 10.3340/jkns.2019.0114.
- Brinjikji W, Starke R M, Murad M H et al. Impact of balloon guide catheter on technical and clinical outcomes: a systematic review and meta-analysis. J Neurointerv Surg. 2018; 10(4): 335–9. DOI: 10.1136/ neurintsurg-2017-013179.
- Pederson J M, Reierson N L, Hardy N et al. Comparison of Balloon Guide Catheters and Standard Guide Catheters for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. World Neurosurg. 2021; 154: 144–53. DOI: 10.1016/j.wneu.2021.07.034.
- Nikoubashman O, Dekeyzer S, Riabikin A et al. True First-Pass Effect. First-Pass Complete Reperfusion Improves Clinical Outcome in Thrombectomy Stroke Patients. Stroke. 2019; 50(8): 2140–6. DOI: 10.1161/STROKEAHA.119.025148.
Demetrius K Lopes is a neurosurgeon at Advocate Health in Chicago, USA, where he is the Comprehensive Stroke Program surgical director, as well as the director of Cerebrovascular Surgery. Lopes is a paid consultant of CERENOVUS, part of Johnson & Johnson MedTech.
i. EMBOGUARD balloon guide catheter and CEREBASE DA guide sheath are incompatible and should not be used together.
ii. Better durability and compatibility than Sofia Plus, Ace 68, Jet 7, React 71 and Vecta 71 catheters in a benchtop study. Better durability than React 68 catheter in a benchtop study. The third-party trademarks used herein are the properties of their respective owners.
iii. Total restoration of pre-stroke blood flow.
iv. A six-point disability scale to measure outcomes in stroke patients.