Balloon guide catheter versus different sizes of non-balloon guide catheter; a MR CLEAN Registry analysis

Abstract Introduction Balloon guide catheters (BGC) are used to prevent distal emboli during endovascular treatment (EVT) for acute ischemic stroke. Although literature reports benefit of BGC, these are not universally used and randomized head-to-head comparisons are lacking. This study compared functional, safety, and technical outcomes between patients treated with different sizes non-BGC and with BGC during EVT in a nationwide prospective multicenter registry. Methods Patients from the MR CLEAN Registry (2014–2018), who underwent EVT with a 5-7French (Fr) non-BGC, a 8-9Fr non-BGC, or a 8-9Fr BGC were included. Primary outcome was the modified Rankin Scale (mRS) score at 90 days, secondary outcomes included procedure time and first-attempt successful reperfusion (eTICI ≥ 2C). Treatment-effect modification and subgroups were analyzed according to first-line thrombectomy technique: stent retriever (SR) or direct aspiration (ASP). Results In total 2808 patients were included, and 1671 (60%) were treated with 8-9Fr BGC. Overall, no significant differences in clinical outcome were seen between non-BGC and BGC groups. The 8-9Fr non-BGC was associated with lower first-attempt successful revascularization rates compared to BGC (aOR:0.76, 95%CI:0.59-0.998), the 5-7 Fr non-BCG was not. Regression analysis showed a significant interaction between BGC use and device type. In the subgroup with SR as first-line technique, 90 day mRS scores were significantly higher in the 8-9Fr non-BGC group compared with BCG (acOR:0.77; 95%CI:0.59-0.996), but not in the 5-7Fr non-BCG. Direct aspiration combined with 5-7Fr non-BGC resulted in higher first-attempt rates compared to BGC (aOR:1.75; 95%CI:1.16-2.63). Conclusion This large prospective multicenter registry showed no differences in clinical outcome between patients treated with 5-7Fr non-BGC, 8-9Fr non-BGC, and 8-9Fr BGC. Subgroup analyses, however, suggest that BCG outperforms the non-BGC when SR is used as first-line technique.