Use of balloon guide catheter with Solitaire improves results of acute ischaemic stroke treatment

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A study presented at the Society of NeuroInterventional Surgery (SNIS) meeting (29 July–1 August, Miami, USA) suggests that the use of a balloon guide catheter with the Solitaire Stent retriever in acute ischaemic stroke results in superior recanalisation results, faster procedure time, decreased need for rescue therapy, and improved clinical outcome.

Thanh Nguyen, Boston Medical Center, USA, presented the results of a substudy of the North American Solitaire Stent-Retriever Acute Stroke (NASA) Registry.

Authors of the study noted in an abstract that efficient and timely recanalisation is an important goal in acute stroke endovascular therapy. “The goal of this study was to evaluate the role of the balloon guide catheter and recanalisation success in a sub-study of the North American Solitaire Stent-Retriever Acute Stroke Registy (NASA),” they wrote.

The investigator-initiated NASA Registry recruited 24 clinical sites in North America to submit demographic, clinical, site-adjudicated angiographic and clinical outcome data on consecutive patients treated with the Solitaire FR device (Covidien). Balloon guide catheter was used at the discretion of the treating physicians, the authors noted.

Details of the study:

There were 354 patients included in this study. In 16 of these patients, there were no details of balloon guide catheter use reported, leaving 338 patients in the study group.

One hundred and forty nine of these 338 (44%) had placement of the balloon guide catheter. The mean age of patients was 67.3+15.2 years and median NIHSS was 18. Patients with balloon guide catheter had more hypertension (82% vs. 73%; p=0.05), atrial fibrillation (51% vs. 33%; p=0.001) and were more commonly administered tissue plasminogen activator (tPA, 51% vs. 39%; p=0.02) compared to patients without balloon guide catheter.

Time from symptom onset to groin puncture and number of passes were similar between the two groups. Procedure time was shorter in patients with balloon guide catheter (120 vs. 161 minutes, p=0.02) and less rescue therapy was used in patients with balloon guide catheter (20% vs. 28.6%, p=0.05). Thrombolysis in cerebral infarction (TICI) 2b/3, TICI 3 recanalisation was higher in patients with balloon guide catheter compared to patients without (TICI 2b/3: 75% vs. 70%; TICI 3 53% vs. 32.5% p<0.001). Distal emboli and emboli in the new territory were similar between the two groups, the authors noted.

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