Temporary flow arrest using EMBOGUARD™ balloon guide catheter may improve functional outcomes in acute stroke thrombectomy: a multicenter retrospective study

Abstract

Balloon guide catheters (BGCs) have demonstrated benefits in mechanical thrombectomy (MT) for acute ischemic stroke (AIS), including improved recanalization rates and reduced distal embolization. The EMBOGUARD™ balloon guide catheter (Johnson & Johnson Neurovascular, Irvine, CA) represents a novel design with enhanced flexibility and compatibility with large-bore aspiration catheters. This study aims to evaluate the safety and efficacy of the EMBOGUARD™ BGC compared with non-BGC approaches. We conducted a retrospective multicenter study to analyze patients with AIS due to anterior large vessel occlusions (LVOs) who underwent MT between January 2022 and December 2024. Patients were divided into two groups: those treated with t☺he EMBOGUARD™ BGC and those treated without BGC. Primary outcomes included first-pass effect (FPE), successful recanalization (mTICI ≥2b), procedural time, number of passes, and distal embolization. Secondary outcomes included 90-day functional outcome (modified Rankin Scale [mRS] 0–2), mortality, and symptomatic intracranial hemorrhage (sICH). A total of 178 patients were included (EMBOGUARD: n  = 135, 75.8%; non-BGC: n  = 43, 24.2%). The EMBOGUARD™ group demonstrated comparable rates of FPE (33.3% vs. 37.2%, p  = 0.68) and successful recanalization (86.7% vs. 86.0%, p  = 0.92). Procedural time was significantly shorter in the EMBOGUARD™ group (median 32 min vs. 49 min, p  = 0.004). Distal embolization rates were similar between groups (4.4% vs. 4.7%, p  = 1.00). The EMBOGUARD™ group showed significantly higher rates of favorable functional outcome at 90 days (48.6% vs. 28.1%, p  = 0.04) and non-significantly lower 90-day mortality (13.7% vs. 16.7%, p  = 0.6). Although favorably trending, multivariate logistic regression analysis did not confirm that EMBOGUARD™ was associated with greater odds of FPE (adjusted odds ratio [aOR] 2.01, 95% confidence interval [CI] 0.65–6.41, p  = 0.2), mRS 0–2 at 90 days (aOR 1.36, 95% CI 0.35–5.34, p  = 0.7) or lower odds of mortality at 90 days (aOR 0.32, 95% CI 0.05–1.85, p  = 0.2). The EMBOGUARD™ balloon guide catheter demonstrated comparable technical efficacy with reduced procedural times and improved clinical outcomes compared with non-BGC techniques in endovascular thrombectomy for acute ischemic stroke. These findings support the use of EMBOGUARD™ as a reasonable tool for flow arrest in stroke intervention.