J Korean Neurosurg Soc.  2019 Jul;62(4):389-397. 10.3340/jkns.2018.0165.

The Effects of Balloon-Guide Catheters on Outcomes after Mechanical Thrombectomy in Acute Ischemic Strokes: A Meta-Analysis

• Ahn JH
• Cho SS
• Kim SE
• Kim HC
• Jeon JP

• KMID: 2463669
• DOI: http://doi.org/10.3340/jkns.2018.0165

Abstract

OBJECTIVE
Mechanical thrombectomies with balloon-guide catheters (BGC) are thought to improve successful recanalization rates and to decrease the incidence of distal emboli compared to thrombectomies without BGC. We aimed to assess the effects of BGC on the outcomes of mechanical thrombectomy in acute ischemic strokes.
METHODS
Studies from PubMed, EMBASE, and the Cochrane library database from January 2010 to February 2018 were reviewed. Random effect model for meta-analysis was used. Analyses such as meta-regression and the "trim-and-fill" method were additionally carried out.
RESULTS
A total of seven articles involving 2223 patients were analyzed. Mechanical thrombectomy with BGC was associated with higher rates of successful recanalization (odds ratio [OR], 1.632; 95% confidence interval [CI], 1.293-2.059). BGC did not significantly decrease distal emboli, both before (OR, 0.404; 95% CI, 0.108-1.505) and after correcting for bias (adjusted OR, 1.165; 95% CI, 0.310-4.382). Good outcomes were observed more frequently in the BGC group (OR, 1.886; 95% CI, 1.564-2.273). Symptomatic intracranial hemorrhage and mortality did not differ significantly with BGC use.
CONCLUSION
Our meta-analysis demonstrates that BGC enhance recanalization rates. However, BGC use did not decrease distal emboli after mechanical thrombectomies. This should be interpreted with caution due to possible publication bias and heterogeneity. Additional meta-analyses based on individual patient data are needed to clarify the role of BGC in mechanical thrombectomies.

Keyword

Stroke; Thrombectomy; Meta-analysis

MeSH Terms

Bias (Epidemiology)
Catheters*
Humans
Incidence
Intracranial Hemorrhages
Methods
Mortality
Population Characteristics
Publication Bias
Stroke*
Thrombectomy*

Figure

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  Fig. 1. Flow diagram detailing the identification of relevant studies.

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  Fig. 2. Comparison of successful recanalization (A) and distal emboli (B) after mechanical thrombectomy according to BGC use (BGC vs. non-BGC). OR : odds ratio, CI : confidence interval, BGC : balloon-guiding catheter.

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  Fig. 3. Publication bias in comparison of successful recanalization (A) and distal emboli (B) after mechanical thrombectomy between the two groups of BGC and non-BGC. OR : odds ratio, BGC : balloon-guiding catheter.

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  Fig. 4. Meta-regression of differences in the onset-to-puncture time (OTP) and the log odds ratios for successful recanalization (A) and distal emboli incidence (B) in three studies. The difference in the mean OTP was used in three studies. Each study is represented by a circle, whose size is proportional to the study weight in the meta-analysis. The straight line represents the best line of correlation (p-value=0.015 in A and p-value=0.118 in B).

Reference

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