Does endovascular thrombectomy using super-bore 0.088” large distal platform offer advantages over balloon guide catheters in acute ischemic stroke secondary to large vessel occlusion?

Background Balloon guide catheters (BGCs) can optimize recanalization in endovascular thrombectomies, but recent studies suggest that aspiration catheters sized closely to the target vessel can be effective for recanalization. Objective To compare the outcomes, efficacy, and safety of a single-surgeon experience replacing BGCs with large distal platform (LDP) catheters. Methods This is a retrospective study of patients with anterior circulation large vessel occlusion undergoing endovascular thrombectomies. Our study population was divided based on use of either the Zoom™ 0.088” LDP (Imperative Care, Inc., Campbell, CA, USA) or Walrus™ BGC (Q’Apel Medical, Fremont, CA, USA). Primary outcomes were the thrombectomy technique used, time from groin puncture to recanalization, first pass effect (FPE), degree of final reperfusion (modified treatment in cerebral infarction [mTICI]), postoperative complications, and all-cause mortality at 90 days. Results We analyzed 48 cases: 27 with Walrus™ BGC and 21 with LDP. Contact aspiration was primarily used with LDP ( p < 0.001), while a stent-retriever-based technique was preferred with BGC ( p < 0.001). The median groin-to-recanalization time was shorter for the LDP cohort ( p = 0.001). Both cohorts achieved mTICI ≥ 2b in all cases, with more mTICI of 3 in the LDP cohort ( p = 0.38). The LDP cohort also had a greater FPE ( p = 0.034). Four cases with iatrogenic dissections were observed with Walrus™ BGC ( p = 0.12) and 2 cases with downstream emboli with using the LDP ( p = 0.19). All-cause mortality was similar between cohorts ( p > 0.99). Conclusion The super-bore LDP offers a significant advantage over BGCs, achieving faster reperfusion times without compromising safety or recanalization effectiveness. Switching to super-bore 0.088” Zoom may enhance thrombectomy procedures.