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Original research
Effect of balloon guide catheter on clinical outcomes and reperfusion in Trevo thrombectomy
  1. Thanh N Nguyen1,2,3,
  2. Alicia C Castonguay4,
  3. Raul G Nogueira5,
  4. Diogo C Haussen5,
  5. Joey D English6,
  6. Sudhakar R Satti7,
  7. Jennifer Chen8,
  8. Hamed Farid9,
  9. Candace Borders10,
  10. Erol Veznedaroglu11,
  11. Mandy J Binning11,
  12. Ajit S Puri12,
  13. Nirav A Vora13,
  14. Ron F Budzik13,
  15. Guilherme Dabus14,
  16. Italo Linfante14,
  17. Vallabh Janardhan15,
  18. Amer Alshekhlee16,
  19. Michael G Abraham17,
  20. Randall C Edgell18,
  21. M Asif Taqi19,
  22. Ramy El Khoury20,
  23. Maxim Mokin21,
  24. Aniel Q Majjhoo22,
  25. Mouhammed R Kabbani23,
  26. Michael T Froehler24,
  27. Ira Finch25,
  28. Sameer A Ansari26,
  29. Roberta Novakovic27,
  30. Mohamad Abdalkader1,2,3,
  31. Osama O Zaidat28
  1. 1 Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
  2. 2 Department of Neurosurgery, Boston Medical Center, Boston, Massachusetts, USA
  3. 3 Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
  4. 4 Neurology, University of Toledo, Toledo, OH, US
  5. 5 Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
  6. 6 California Pacific Medical Center, San Francisco, California, USA
  7. 7 Department of Neurointerventional Surgery, Christiana Care Health System, Newark, Delaware, USA
  8. 8 Sidney Kimmel Medical School, Philadelphia, Pennsylvania, USA
  9. 9 Department of Neurointerventional Radiology, St Jude Medical Center, Fullerton, USA
  10. 10 UC Irvine Health School of Medicine, Irvine, California, USA
  11. 11 Department of Neurosurgery, Drexel Neurosciences Institute, Philadelphia, Pennsylvania, USA
  12. 12 University of Massachusetts, Radiology, Worcester, Massachusetts, USA
  13. 13 Department of Radiology, Riverside Radiology and Interventional Associates Inc, Columbus, Ohio, USA
  14. 14 Department of Neurointerventional Surgery, Baptist Cardiac and Vascular Institute, Miami, Florida, USA
  15. 15 Texas Stroke Institute, Plano, Texas, USA
  16. 16 Department of Vascular and Interventional Neurology, DePaul Stroke Center-SSM Neuroscience Institutes, St Louis University, St Louis, Missouri, USA
  17. 17 Departments of Neurology and Interventional Radiology, University of Kansas Medical Center, Kansas, USA
  18. 18 Department of Neurology, St Louis University, St Louis, Missouri, USA
  19. 19 Department of Neurology and Neurosurgery, Los Robles Hospital and Medical Center, Thousand Oaks, California, USA
  20. 20 Department of Neurology, Tulane University, New Orleans, Louisiana, USA
  21. 21 Department of Neurosurgery and Brain Repair, University of South Florida, South Florida, Florida, USA
  22. 22 Department of Neurology, Wayne State School of Medicine, Detroit, Michigan, USA
  23. 23 Department of Neurosurgery, Gundersen Health System, La Crosse, Wisconsin, USA
  24. 24 Departments of Neurology, Neurosurgery, and Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  25. 25 John Muir Health, California, Walnut Creek, USA
  26. 26 Departments of Radiology, Neurology, and Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
  27. 27 Departments of Radiology, Neurology, and Neurotherapeutics, UT Southwestern Medical Center, Dallas, Texas, USA
  28. 28 Departments of Endovascular Neurosurgery and Stroke, St Vincent Mercy Medical Center, Toledo, Ohio, USA
  1. Correspondence to Dr Thanh N Nguyen, Neurology, Neurosurgery, Radiology, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA; Thanh.Nguyen{at}


Introduction The Solitaire stent retriever registry showed improved reperfusion, faster procedure times, and better outcome in acute stroke patients with large vessel occlusion treated with a balloon guide catheter (BGC) and Solitaire stent retriever compared with a conventional guide catheter. The goal of this study was to evaluate whether use of a BGC with the Trevo stent retriever improves outcomes compared with a conventional guide catheter.

Methods The TRACK registry recruited 23 sites to submit demographic, clinical, and site adjudicated angiographic and outcome data on consecutive patients treated with the Trevo stent retriever. BGC use was at the discretion of the physician.

Results 536 anterior circulation patients (of whom 279 (52.1%) had BGC placement) were included in this analysis. Baseline characteristics were notable for younger patients in the BGC group (65.4±15.3 vs 68.1±13.6, P=0.03) and lower rate of hypertension (72% vs 79%, P=0.06). Mean time from symptom onset to groin puncture was longer in the BGC group (357 vs 319 min, P=0.06).Thrombolysis in Cerebral Infarction 2b/3 scores were higher in the BGC cohort (84% vs 75.5%, P=0.01). There was no difference in reperfusion time, first pass effect, number of passes, or rescue therapy. Good clinical outcome at 3 months was superior in patients with BGC (57% vs 40%; P=0.0004) with a lower mortality rate (13% vs 23%, P=0.008). Multivariate analysis demonstrated that BGC use was an independent predictor of good clinical outcome (OR 2; 95% CI 1.3 to 3.1, P=0.001).

Conclusions In acute stroke patients presenting with anterior circulation large vessel occlusion, use of a BGC with the Trevo stent retriever resulted in improved reperfusion, improved clinical outcome, and lower mortality.

  • stroke
  • thrombectomy
  • technique
  • balloon
  • catheter

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  • Contributors OOZ and ACC initiated and led the TRACK registry, and performed the data analysis. TNN drafted the manuscript and its revisions. All authors contributed data and revised the manuscript.

  • Funding Stryker Neurovascular; limited coordinating center administrative grant. Subanalysis supported by a SVIN pilot grant.

  • Competing interests TNN is a consultant for Medtronic. OOZ is a consultant/advisory board member for Stryker Neurovascular and Covidien. OOZ is overall principal investigator for TRACK–no compensation and Arise II–modest. RGN is a consultant/advisory board member for Stryker Neurovascular and Covidien. Stryker Neurovascular (Trevo-2 trial principal investigator–modest; DAWN trial principal investigator–no compensation, TREVO registry steering committee–no compensation), Medtronic (SWIFT trial steering committee–modest; SWIFT-Prime trial steering committee–no compensation; STAR Trial Angiographic Core Lab–significant), Penumbra (3D Separator trial executive committee–no compensation), Neuravi (ARISE-2 steering committee–no compensation), Genentech (physician advisory board–modest), Allm Inc (physician advisory board–no compensation), editor- in-chief Interventional Neurology journal (no compensation). SRS is a consultant for Stryker Neurovascular. JDE is a consultant for Stryker Neurovascular.
    IL is a consultant for Medtronic, Stryker, Penumbra, and Cordis.

  • Patient consent Not required.

  • Ethics approval Institutional review board approval was obtained from each institution’s review board

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data are only available to the coordinating investigators in the study.