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Case series
Balloon guide catheter improvements in thrombectomy outcomespersist despite advances in intracranial aspiration technology
  1. Jordi Blasco1,
  2. Josep Puig2,
  3. Pepus Daunis-i-Estadella3,
  4. Eva González4,
  5. Juan Jose Fondevila Monso5,
  6. Xabier Manso5,
  7. Rafael Oteros6,
  8. Elvira Jimenez-Gomez6,
  9. Isabel Bravo Rey7,
  10. Pedro Vega8,
  11. Eduardo Murias8,
  12. Jose Maria Jimenez8,
  13. Antonio López-Rueda9,
  14. Arturo Renú10,
  15. Sonia Aixut11,
  16. Oscar Chirife Chaparro12,
  17. Santiago Rosati13,
  18. Manuel Moreu14,
  19. Sebastian Remollo15,
  20. Yeray Aguilar Tejedor16,
  21. Mikel Terceño17,18,
  22. Antonio Mosqueira19,
  23. Raul G Nogueira20,
  24. Luis San Roman9
  1. 1Neurointerventional Department CDI, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
  2. 2IDI-Radiology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Catalunya, Spain
  3. 3Department of Computer Science, Applied Mathematics and Statistics, University of Girona, Girona, Catalunya, Spain
  4. 4Interventional Neuroradiology, Radiology, Cruces University Hospital, Barakaldo, País Vasco, Spain
  5. 5Interventional Neuroradiology, Radiology, Hospital Universitario Cruces, Bilbao, País Vasco, Spain
  6. 6Diagnostic and Therapeutical Neuroradiology Unit, Reina Sofia University Hospital, Cordoba, Andalucía, Spain
  7. 7Neurorradiologia, Reina Sofia University Hospital, Cordoba, Andalucía, Spain
  8. 8Radiology, HUCA, Oviedo, Asturias, Spain
  9. 9Interventional Neuroradiology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
  10. 10Comprehensive Stroke Unit, Hospital Clinic de Barcelona, Barcelona, Spain
  11. 11Neuroradiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
  12. 12Interventional Neuroradiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
  13. 13Department of Radiology, Clinical San Carlos Hospital, Hospital Clinico Universitario San Carlos, Madrid, Spain
  14. 14Neurointerventional Unit, Hospital Clinico Universitario San Carlos, Madrid, Spain
  15. 15Interventional Neuroradiology Unit, University Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain
  16. 16Radiology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Canarias, Spain
  17. 17Stroke Unit, Department of Neurology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
  18. 18Interventional Neuroradiology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
  19. 19Neuroradiology Department, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
  20. 20Neurology and Interventional Neuroradiology, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Dr Jordi Blasco, Neurointerventional Department C.D.I, Hospital Clinic de Barcelona, Barcelona 08036, Spain; 30018jba{at}


Background First-pass effect (FPE) has been established as a key metric for technical success and strongly correlates with better clinical outcomes. Most data supporting improved outcomes with the use of a balloon guide catheter (BGC) predate the advent of last-generation large-bore intracranial aspiration catheters. We aim to evaluate the impact of BGC in FPE and clinical outcomes in a large cohort of patients treated with contemporary technology.

Methods Patients were recruited from the prospectively ongoing ROSSETTI registry. This registry includes all consecutive patients with anterior circulation large-vessel occlusion (LVO) from 10 comprehensive stroke centers in Spain. Demographic, clinical, angiographic, and clinical outcome data were compared between BGC and non-BGC groups. FPE was defined as the achievement of mTICI2c–3 after a single device pass.

Results 426 patients were included out of which 271 (63.62%) used BCG. BGC-treated patients had higher FPE rate (45.8% vs 27.7%; P<0.001), higher final mTICI ≥2 c recanalization rate (76.8% vs 50.3%, respectively; P<0.001), shorter procedural time [median (IQR), 30 (19–58) vs 43 (33–71) min; P<0.001], higher NIHSS difference from admission to 24 hours [median (IQR), 8 (2–12) vs 3 (0–10); P=0.001], and lower mortality rate (17.6% vs 29.8%, P=0.026) compared with non-BGC patients. BGC use was an independent predictor of FPE (OR 2.197, 95% CI 1.436 to 3.361; P<0.001), and excellent clinical outcome at 3 months (OR 0.34, 95% CI 0.17 to 0.68; P=0.002).

Conclusions Our results support the benefit of BGC use on angiographic and clinical outcomes in anterior circulation LVO ischemic stroke remain significant even when considering recent improvements in intracranial aspiration technology.

  • stroke
  • thrombectomy

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  • Collaborators Ana Caicedo Marin, Data Manager, Hospital Clinic of Barcelona; Federico Zarco Contreras, Neurointerventional Department, CDI.

  • 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 None declared.

  • Patient consent for publication Not required.

  • Ethics approval ROSSETTI Registry has been approved by the IEC of Hospital Clinic of Barcelona HCB/2019/0152.

  • 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.

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