Background Balloon guide catheter (BGC) in stent retriever based thrombectomy (BGC+SR) for patients with large vessel occlusion strokes (LVOS) improves outcomes. It is conceivable that the addition of a large bore distal access catheter (DAC) to BGC+SR leads to higher efficacy. We aimed to investigate whether the combined BGC+DAC+SR approach improves angiographic and clinical outcomes compared with BGC+SR alone for thrombectomy in anterior circulation LVOS.
Methods Consecutive patients with anterior circulation LVOS from June 2019 to November 2020 were recruited from the ROSSETTI registry. Demographic, clinical, angiographic, and outcome data were compared between patients treated with BGC+SR alone versus BGC+DAC+SR. The primary outcome was first pass effect (FPE) rate, defined as near complete/complete revascularization (modified Thrombolysis in Cerebral Infarction (mTICI) 2c–3) after single device pass.
Results We included 401 patients (BGC+SR alone, 273 (66.6%) patients). Patients treated with BGC+SR alone were older (median age 79 (IQR 68–85) vs 73.5 (65–82) years; p=0.033) and had shorter procedural times (puncture to revascularization 24 (14–46) vs 37 (24.5–63.5) min, p<0.001) than the BGC+DAC+SR group. Both approaches had a similar FPE rate (52% in BGC+SR alone vs 46.9% in BGC+DAC+SR, p=0.337). Although the BGC+SR alone group showed higher rates for final successful reperfusion (mTICI ≥2b (86.8% vs 74.2%, p=0.002) and excellent reperfusion, mTICI ≥2 c (76.2% vs 55.5%, p<0.001)), there were no significant differences in 24 hour National Institutes of Health Stroke Scale score or rates of good functional outcome (modified Rankin Scale score of 0–2) at 3 months across these techniques.
Conclusions Our data showed that addition of distal intracranial aspiration catheters to BGC+SR based thrombectomy in patients with acute anterior circulation LVO did not provide higher rates of FPE or improved clinical outcomes.
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Collaborators ROSSETTI Group: González Díaz E, Labayen Azparren I, Fondevila Monsó J, Manso del Caño X, Vega P, Murias E, Jiménez Pérez JM, Chaviano Grajera J, Castañon Apilanez M, Lopez Cancio E, Oteros Fernández R, Jiménez-Gómez E, Bravo Rey I, Romero Saucedo V, Delgado Acosta F, San Román L, López-Rueda A, Macho J, Macías N, Zarco F, Renú Jornet A, Blasco J, Moreu M, Perez-García C, Rosati S, López-Frias A, Chirife Chaparro O, Aixut S, Rodríguez Caamaño I, de Miquel Miquel MA, Barranco Pons R, Aja Rodríguez L, Cuba Camasca V, Terceño M, Bashir S, Paul L, Werner M, Castaño C, Remollo S, Pumar JM, Mosqueira A, Aguilar Tejedor Y, Cubillo Prieto D, Bravo de Laguna Toboada A, Méndez JC, Bermúdez-Coronel I, Fandiño E, Gallego Leon JI, López Hernandez N, Moliner S, Rayon JC.
Contributors All authors contributed equally to the design, writting, and reviewing of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests RGN reports consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Imperative Care, Medtronic, Phenox, Prolong Pharmaceuticals, and Stryker Neurovascular, and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, and Perfuze.
Provenance and peer review Not commissioned; externally peer reviewed.
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