2025 American Academy of Neurology Abstract Website

Bishow Chandra Mahat¹, Anmol Almast², Mohamed Fahmy Doheim³, Vanessa Dwairi⁴, Abdullah Al-Qudah⁵, Lucas Rios Rocha⁶, Marcelo Rocha¹, Nirav Bhatt¹, Matthew Starr¹, Michael Lang⁷, Bradley Gross⁷, Raul Nogueira¹, Alhamza Al-Bayati¹
¹UPMC Stroke Institute, ²School of Medicine, University of Pittsburgh, ³Alexandria Faculty of Medicine, ⁴NYU Langone Neurology, New York University (NYU), ⁵University of Pittsburgh Medical Center, ⁶UPMC, ⁷Neurosurgery, UPMC

Objective:

To evaluate the performance of a newer-generation balloon guide catheter (Emboguard) in the treatment of anterior circulation large vessel occlusion.

Background:

Growing interest in optimizing endovascular thrombectomy (EVT) procedural techniques led to advancements in catheter technology and thrombectomy devices. Balloon guide catheters (BGC) facilitate proximal flow arrest and have demonstrated improved revascularization and functional outcomes.

Design/Methods:

A prospectively maintained EVT database was reviewed to identify all patients who underwent EVT using the Emboguard BGC. Outcomes included rates of complete and successful recanalization, number of passes, NIHSS at discharge, functional independence (mRS 0-2), favorable outcome (mRS 0-3), and mortality at 90 days. First-pass effect (FPE, mTICI 2c/3 after the first pass), modified-FPE (mTICI 2b-3 after the first pass), symptomatic intracranial hemorrhage, and mortality were evaluated.

Results:

72 patients were identified. 56.94% were female, and the median age was 73 years [IQR 66.5-83]. The majority (88.9%) had middle cerebral artery (MCA) occlusion, with a median ASPECTS score of 9 [IQR 7-10]. Approximately 26.39% of patients received intravenous thrombolytics. Successful recanalization (mTICI 2b/3) was achieved in 98.61% (71/72) of cases, while complete recanalization (TICI 2c/3) occurred in 76.39% (55/72), with a median of 1 pass (IQR 1-2). FPE and modified-FPE were achieved in 48.61% and 56.94% of cases, respectively. The median NIHSS improved significantly from 17 (IQR 11-21) at baseline to 4 (IQR 1-12) at discharge. Symptomatic intracranial hemorrhage occurred in only 1 case (1.39%). At 90 days, functional independence (mRS 0-2) was achieved in 37.5%, favorable outcomes (mRS 0-3) in 57.14%, and mortality occurred in 25% of patients.

Conclusions:

The Emboguard BGC showed promising results, demonstrating high rates of first-pass effect (FPE) and improved recanalization rates, all while maintaining a favorable safety profile. Prospective comparative studies are needed to validate these findings and further establish its efficacy in clinical practice.