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PT  - JOURNAL ARTICLE
AU  - Podlasek, A.
AU  - Dhillon, P.S.
AU  - Jewett, G.
AU  - Shahein, A.
AU  - Goyal, M.
AU  - Almekhlafi, M.
TI  - Clinical and Procedural Outcomes with or without Balloon Guide Catheters during Endovascular Thrombectomy in Acute Ischemic Stroke: A Systematic Review and Meta-analysis with First-line Technique Subgroup Analysis
AID  - 10.3174/ajnr.A7164
DP  - 2021 Aug 01
TA  - American Journal of Neuroradiology
PG  - 1464--1471
VI  - 42
IP  - 8
4099  - http://www.ajnr.org/content/42/8/1464.short
4100  - http://www.ajnr.org/content/42/8/1464.full
SO  - Am. J. Neuroradiol.2021 Aug 01; 42
AB  - BACKGROUND: Balloon guide catheters are increasingly used to improve clot retrieval by temporarily stopping proximal blood flow during endovascular thrombectomy.PURPOSE: Our aim was to provide a summary of the literature comparing the procedural and clinical outcomes of endovascular thrombectomy with or without balloon guide catheters, depending on the first-line technique used.DATA SOURCES: We used PubMed/MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews.STUDY SELECTION: We chose studies that compared using balloon guide catheters with not using them.DATA ANALYSIS: Random effects meta-analysis was performed to compare the procedural outcomes measured as the first-pass effect, successful reperfusion, number of passes, procedural duration, arterial puncture to reperfusion time, distal emboli, and clinical outcomes.DATA SYNTHESIS: Overall, a meta-analysis of 16 studies (5507 patients, 50.8% treated with balloon guide catheters and 49.2% without them) shows that the use of balloon guide catheters increases the odds of achieving a first-pass effect (OR = 1.92; 95% CI, 1.34–2.76; P < .001), successful reperfusion (OR = 1.85; 95% CI, 1.42–2.40; P < .001), and good functional outcome (OR =1.48; 95% CI, 1.27–1.73; P < .001). Balloon guide catheters reduce the number of passes (mean difference = −0.35; 95% CI, −0.65 to −0.04; P = .02), procedural time (mean difference = −19.73; 95% CI, −34.63 to −4.83; P = .009), incidence of distal or new territory emboli (OR = 0.5; 95% CI, 0.26–0.98; P = .04), and mortality (OR = 0.72; 95% CI, 0.62–0.85; P < .001). Similar benefits of balloon guide catheters are observed when the first-line technique was a stent retriever or contact aspiration, but not for a combined approach.LIMITATIONS: The analysis was based on nonrandomized trials with a moderate risk of bias.CONCLUSIONS: Current literature suggests improved clinical and procedural outcomes associated with the use of balloon guide catheters during endovascular thrombectomy, especially when using the first-line stent retriever.eTICIextended TICI scoresICHsymptomatic intracranial hemorrhage