Early clinical experience with the Emboguard Balloon Guide Catheter: impact on technical success and patient outcomes in large vessel occlusion thrombectomy.

Background: This study evaluated the performance of the newer-generation Emboguard Balloon Guide Catheter (EBGC) in treating anterior circulation large vessel occlusions (LVOs).

Methods: A prospectively maintained endovascular thrombectomy database was reviewed to identify consecutive non-tandem LVO patients treated with the EBGC. Procedural outcomes included rates of complete recanalization (modified Thrombolysis in Cerebral Infarction (mTICI) 2c/3), successful recanalization (mTICI 2b/3), first-pass effect (FPE) (mTICI 2c/3 after the first pass), modified FPE (mTICI 2b/3 after the first pass), and the number of passes. Clinical outcomes assessed included National Institutes of Health Stroke Scale (NIHSS) scores at discharge, functional independence (modified Rankin Scale (mRS) 0-2), and fair outcomes (mRS 0-3). Safety outcomes evaluated included symptomatic intracranial hemorrhage (sICH) and 90-day mortality.

Results: Of the 72 patients included, 56.9% (41/72) were female, with a median age of 73 years (IQR 67-83). Most patients presented with middle cerebral artery (MCA) occlusions (M1 in 59.7% (43/72) and dominant/co-dominant M2 in 25.0% (18/72)). Successful recanalization (mTICI 2b/3) was achieved in 98.6% (71/72) of cases, and complete recanalization (mTICI 2c/3) was achieved in 76.4% (55/72), with a median of 1 pass (IQR 1-2). FPE and modified FPE were achieved in 48.6% (35/72) and 56.9% (41/72) of cases, respectively. The median NIHSS improved significantly from 17 (IQR 11-21) at baseline to 4 (IQR 1-12) at discharge. sICH occurred in only 1.4% (1/72) of cases. At 90 days, 42.6% (23/54) of patients achieved functional independence (mRS 0-2), and mRS 0-3 in 63.2% (36/57).

Conclusions: The EBGC demonstrated promising potential with high rates of FPE and successful recanalization together with clinical improvements and a favorable safety profile.