Comparison of Balloon Guide Catheter and Non-Balloon Techniques in Middle Cerebral Artery (MCA) and Proximal M3 Occlusion Thrombectomy: A Retrospective Two-Center Study.

Authors

Wook-Joo Kim, Shang Hun Shin, Jung Min Choi, Sung Won Youn

Published in

Neurology India. Volume 74. Issue 4. Pages 616-620. Jul 01, 2026. Epub Jul 21, 2026.

Abstract

While balloon guide catheters (BGCs) are widely used during endovascular thrombectomy (EVT) for large vessel occlusions, prior studies evaluated heterogeneous occlusion locations. The specific benefits of BGCs in M1, or more distal middle cerebral artery (MCA) occlusions remain uncertain.
We retrospectively analyzed 61 patients with acute ischemic stroke due to M1, M2, or proximal M3 occlusion who underwent EVT at two tertiary centers between January 2020 and December 2021. Patients were treated using the stent retriever thrombectomy (SRT), direct aspiration first-pass technique (ADAPT), or combined techniques, with or without BGC, at the operator's discretion. Primary endpoints were successful recanalization (mTICI ≥2b), first-pass recanalization, and procedural time. Clinical outcomes included the 90-day modified rankin scale (mRS), symptomatic intracranial hemorrhage, and mortality.
Among the 61 patients (mean age 68.9 ± 12.8 years), 35 (57.4%) were treated with BGC. Successful recanalization rates were similar between the BGC and non-BGC groups (88.6% vs. 92.3%, P = 0.960). However, first-pass recanalization was lower in the BGC group (42.9% vs. 69.2%, P = 0.041), and procedural time was longer (57.1 ± 29.6 vs. 38.4 ± 19.7 min, P = 0.005). No significant differences were observed in functional independence at 90 days (40.0% vs. 50.0%, P = 0.440), symptomatic hemorrhage, or mortality. In multivariate logistic regression adjusting for age, baseline NIHSS, occlusion site, and recanalization success, BGC use was not independently associated with good functional outcome.
In M1 and more distal MCA occlusions, BGC use was not associated with improved angiographic or clinical outcomes and was linked to lower first-pass recanalization rates and longer procedural times. These exploratory findings indicate that the utility of BGCs may depend on the occlusion location and procedural context, supporting a more tailored approach to device selection rather than a uniform preference for BGC use.

PMID:
42478393
Bibliographic data and abstract were imported from PubMed on 21 Jul 2026.

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