Balloon guide catheter – a different tale of an old story
Balloon guide catheters have been around for some time in ischemic stroke intervention, as have been the debates concerning their potential advantages and disadvantages, their potential usefulness, or the lack thereof. Frankly, most technical discussions at any stroke meeting for several years will stumble on the topic of balloon guide, and key-opinion leaders and stroke experts will argue among themselves about this topic. Since no randomized data compare the usefulness of a balloon guide vs. a standard guide catheter, no adequate answer can be given to this question, and the debates will continue. This will be a quick recap of what features could be considered valuable and some tricks and tips for a novel user of balloon guide catheters.
Effectiveness of balloon guide catheter when and how?
Since randomized evidence for balloon guide catheters’ usefulness is lacking, since the best available evidence for their use is not good enough and will still be debatable, we should switch as a community from an “I am a balloon guide user “ and “ I am not a balloon guide user” approach to a more subtle more constructive, technical process in which we ask ourselves before each intervention: could a balloon guide catheter render this intervention safer in theory? Will I be more comfortable with intracranial circulation opened in managing the cervical lesion with or without the balloon guide?
1 Pederson JM, Reierson NL, Hardy N, et al. Comparison of Balloon Guide Catheters and Standard Guide Catheters for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. World Neurosurg. 2021;154:144-153.e21. doi:10.1016/j.wneu.2021.07.034
2 Blasco J, Puig J, López-Rueda A, et al. Addition of intracranial aspiration to balloon guide catheter does not improve outcomes in large vessel occlusion anterior circulation stent retriever based thrombectomy for acute stroke. J Neurointerv Surg 2022;14:863–7. doi:10.1136/neurintsurg-2021-017760
3 Bourcier R, Marnat G, Labreuche J, et al. Balloon guide catheter is not superior to conventional guide catheter when stent retriever and contact aspiration are combined for stroke treatment. Neurosurgery 2021;88:E83–90. doi:10.1093/neuros/nyaa315
4 Dargazanli C, Mahmoudi M, Cappucci M, et al. Angiographic Patterns and Outcomes Achieved by Proximal Balloon Occlusion in Symptomatic Carotid Artery Stenosis Stenting. Clin Neuroradiol 2020;30:363–72. doi:10.1007/s00062-019-00770-8
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