Robert-Jan B Goldhoorn1, Nele Duijsters2, Charles B L M Majoie3, Yvo B W E M Roos4, Diederik W J Dippel5, Adriaan C G M van Es6, Jan Albert Vos7, Jelis Boiten8, Robert J van Oostenbrugge2, Wim H van Zwam9. 1. Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Room 4.R1.032, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands. Electronic address: robertjan.goldhoorn@mumc.nl. 2. Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Room 4.R1.032, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands. 3. Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands. 4. Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands. 5. Department of Neurology, Erasmus University Medical Center, University Medical Center, Rotterdam, The Netherlands. 6. Department of Radiology, Erasmus University Medical Center, University Medical Center, Rotterdam, The Netherlands. 7. Department of Radiology, Sint Antonius Hospital, Nieuwegein, The Netherlands. 8. Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands. 9. Department of Radiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Room 4.R1.032, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
Abstract
PURPOSE: To compare outcomes after endovascular treatment (EVT) for acute ischemic stroke with and without the use of a balloon guide catheter (BGC) in clinical practice. MATERIALS AND METHODS: Data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN) Registry were used, in which all patients who underwent EVTfor anterior-circulation stroke in The Netherlands between 2014 and 2016 were enrolled. Primary outcome was modified Rankin scale (mRS) score at 90 days. Secondary outcomes included reperfusion grade (extended Thrombolysis In Cerebral Infarction [eTICI] score) and National Institutes of Health Stroke Scale (NIHSS) score 24-48 hours after intervention. The association between the use of a BGC and outcomes was estimated with logistic regression adjusted for age, sex, prestroke mRS score, NIHSS score, collateral grade, and time from onset to EVT. RESULTS:A total of 887 patients were included. Thrombectomy was performed with the use of a BGC in 528 patients (60%) and without in 359 patients (40%). There was no significant association between use of a BGC and a shift on the mRS toward better outcome (adjusted common odds ratio, 1.17; 95% confidence interval [CI], 0.91-1.52). Use of a BGC was associated with higher eTICI score (adjusted common OR, 1.33; 95% CI, 1.04-1.70) and improvement of ≥ 4 points on the NIHSS (adjusted OR, 1.40; 95% CI, 1.04-1.88). CONCLUSIONS: In clinical practice, use of a BGC was associated with higher reperfusion grade and early improvement of neurologic deficits, but had no positive effect on long-term functional outcome.
RCT Entities:
PURPOSE: To compare outcomes after endovascular treatment (EVT) for acute ischemic stroke with and without the use of a balloon guide catheter (BGC) in clinical practice. MATERIALS AND METHODS: Data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands (MR CLEAN) Registry were used, in which all patients who underwent EVT for anterior-circulation stroke in The Netherlands between 2014 and 2016 were enrolled. Primary outcome was modified Rankin scale (mRS) score at 90 days. Secondary outcomes included reperfusion grade (extended Thrombolysis In Cerebral Infarction [eTICI] score) and National Institutes of Health Stroke Scale (NIHSS) score 24-48 hours after intervention. The association between the use of a BGC and outcomes was estimated with logistic regression adjusted for age, sex, prestroke mRS score, NIHSS score, collateral grade, and time from onset to EVT. RESULTS: A total of 887 patients were included. Thrombectomy was performed with the use of a BGC in 528 patients (60%) and without in 359 patients (40%). There was no significant association between use of a BGC and a shift on the mRS toward better outcome (adjusted common odds ratio, 1.17; 95% confidence interval [CI], 0.91-1.52). Use of a BGC was associated with higher eTICI score (adjusted common OR, 1.33; 95% CI, 1.04-1.70) and improvement of ≥ 4 points on the NIHSS (adjusted OR, 1.40; 95% CI, 1.04-1.88). CONCLUSIONS: In clinical practice, use of a BGC was associated with higher reperfusion grade and early improvement of neurologic deficits, but had no positive effect on long-term functional outcome.
Authors: Grzegorz Meder; Paweł Żuchowski; Wojciech Skura; Violetta Palacz-Duda; Milena Świtońska; Magdalena Nowaczewska; Paweł Sokal Journal: J Clin Med Date: 2021-04-21 Impact factor: 4.241