BACKGROUND: Balloon guide catheters (BGCs) are designed to induce flow arrest during mechanical thrombectomy procedures for acute ischemic stroke due to large-vessel occlusion and have been associated with improved clinical and angiographic outcomes. We conducted a systematic review and meta-analysis evaluating the relative technical and clinical outcomes associated with BGC versus non-BGC approaches.

METHODS: A systematic review of clinical literature using the PubMed database was undertaken to identify multi-arm studies published between 2010 and 2021 reporting the use of BGC versus non-BGC approaches for stroke treatment. Data collected included complete recanalization (thrombolysis in cerebral infarction, TICI), first-pass effect TICI 3, puncture-to recanalization time, number of endovascular attempts, distal embolization, symptomatic intracerebral hemorrhage, 90-day modified Rankin Scale score 0e2, and 90-day mortality. Subgroup analyses assessed the impact of treatment device (stent-retrievers, contact aspiration, combination therapy, and not specified/other). A random effects model was fit for each outcome measure.

RESULTS: Fifteen studies were included. Compared with non-BGC approaches, patients treated with BGCs had greater odds of TICI 3 (odds ratio [OR] 1.57; 95% confidence interval [95% CI] 1.08e2.29) and first-pass effect TICI 3 (OR 3.63; 95% CI 2.34e5.62), reduced puncture-to-revascularization time (mean difference e7.8; 95% CI e13.3 to e2.2), fewer endovascular attempts (mean difference e0.47; 95% CI e0.68 to e0.26), reduced odds of distal emboli (OR 0.34; 95% CI 0.17e0.71) and symptomatic intracerebral hemorrhage (OR 0.66; 95% CI 0.51e0.86), greater odds of 90-day modified Rankin Scale score 0e2 (OR 1.51; 95% CI 1.27e1.79), and reduced odds of mortality (OR 0.69; 95% CI 0.57e0.82).

CONCLUSIONS: BGCs yield superior technical and clinical outcomes while reducing patient complications.