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Case series
Addition of intracranial aspiration to balloon guide catheter does not improve outcomes in large vessel occlusion anterior circulation stent retriever based thrombectomy for acute stroke
  1. Jordi Blasco1,
  2. Josep Puig2,
  3. Antonio López-Rueda3,
  4. Pepus Daunis-i-Estadella4,
  5. Laura Llull5,
  6. Federico Zarco6,
  7. Napoleon Macias6,
  8. Juan Macho1,
  9. Eva González7,
  10. Ion Labayen8,
  11. Pedro Vega9,
  12. Eduardo Murias9,
  13. Elvira Jimenez-Gomez10,
  14. Isabel Bravo Rey11,
  15. Manuel Moreu12,
  16. Carlos Pérez-García13,
  17. Oscar Chirife Chaparro14,
  18. Sonia Aixut15,
  19. Mikel Terceño16,17,
  20. Mariano Werner18,
  21. José Manuel Pumar19,
  22. Yeray Aguilar Tejedor20,
  23. Jose Carlos Mendez21,
  24. Sarai Moliner22,
  25. Raul G Nogueira23,
  26. Luis San Roman1
  27. on behalf of the ROSSETTI Group
    1. 1 Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Spain
    2. 2 IDI-Radiology, Doctor Josep Trueta University Hospital of Girona, Girona, Spain
    3. 3 Department of Interventional Neuroradiology, Clinic University Hospital, Barcelona, Barcelona, Spain
    4. 4 Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Catalunya, Spain
    5. 5 Neurology Department, Hospital Clinic de Barcelona, Barcelona, Catalonia, Spain
    6. 6 Comprehensive Stroke Unit, Hospital Clinic de Barcelona, Barcelona, Spain
    7. 7 Interventional Neuroradiology, Radiology, Hospital Cruces, Bilbao, Spain
    8. 8 Cruces University Hospital, Barakaldo, País Vasco, Spain
    9. 9 Radiology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
    10. 10 Diagnostic and Therapeutical Neuroradiology Unit, Hospital Reina Sofía, Córdoba, Spain
    11. 11 Neurorradiologia, Hospital universitario Reina Sofia, Córdoba, Spain
    12. 12 Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
    13. 13 Interventional Neuroradiology, Hospital Clinico Universitario San Carlos, Madrid, Spain
    14. 14 Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
    15. 15 Neuroradiology, Hospital Universitari de Bellvitge, Barcelona, Cataluña, Spain
    16. 16 Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
    17. 17 Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
    18. 18 Department of Radiology, Hospital Clinic I Provincial de Barcelona, University Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain
    19. 19 Neuroradiology, Hospital Clinico Universitario, Santiago de Compostela, Spain
    20. 20 Radiology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Canarias, Spain
    21. 21 Interventional Neuroradiology Unit, Radiology, Hospital Ramón y Cajal, Madrid, Spain
    22. 22 Interventional Neuroradiology, Hospital General Universitario de Alicante, Alicante, Valenciana, Spain
    23. 23 Neurology and Interventional Neuroradiology, Emory University School of Medicine, Atlanta, Georgia, USA
    1. Correspondence to Dr Jordi Blasco, Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, C/ Villarroel 170. 08036, Spain; 30018jba{at}


    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.

    • stroke
    • thrombectomy
    • stent

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    • Twitter @jordiblascoa, @AntonioLR81, @manumoreu, @oscarsabino

    • 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.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.