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Matched-pair analysis of patients with ischemic stroke undergoing thrombectomy using next-generation balloon guide catheters
  1. Lily H Kim1,
  2. John Choi1,
  3. James Zhou2,
  4. Dylan Wolman3,
  5. Arjun V Pendharkar1,
  6. Maarten G Lansberg4,
  7. Gregory W Albers4,
  8. Robert Dodd5,
  9. Huy M Do6,
  10. Benjamin Pulli6,
  11. Jeremy J Heit6,
  12. Nicholas A Telischak6
  1. 1Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
  2. 2California Northstate University College of Medicine, Elk Grove, California, USA
  3. 3Radiology, Kaiser Permanente, Portland, Oregon, USA
  4. 4Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
  5. 5Neurosurgery and Radiology, Stanford University, Stanford, California, USA
  6. 6Radiology, Neuroadiology and Neurointervention Division, Stanford University, Stanford, California, USA
  1. Correspondence to Dr Nicholas A Telischak, Neurointerventional Radiology, Stanford University, Stanford, California, USA; ntelischak{at}


Background Balloon guide catheters (BGCs) have not been widely adopted, possibly due to the incompatibility of past-generation BGCs with large-bore intermediate catheters. The next-generation BGC is compatible with large-bore catheters. We compared outcomes of thrombectomy cases using BGCs versus conventional guide catheters.

Methods We conducted a retrospective study of 110 thrombectomy cases using BGCs (n=55) and non-BGCs (n=55). Sixty consecutive thrombectomy cases in whom the BOBBY BGC was used at a single institution between February 2021 and March 2022 were identified. Of these, 55 BGC cases were 1:1 matched with non-BGC cases by proceduralists, age, gender, stent retriever + aspiration device versus aspiration-only, and site of occlusion. First-pass effect was defined as Thrombolysis In Cerebral Infarction 2b or higher with a single pass.

Results The BGC and non-BGC cohorts had similar mean age (67.2 vs 68.9 years), gender distribution (43.6% vs 47.3% women), median initial National Institutes of Health Stroke Scale score (14 vs 15), and median pretreatment ischemic core volumes (12 mL vs 11.5 mL). BGC and non-BGC cases had similar rates of single pass (60.0% vs 54.6%), first-pass effect (58.2% vs 49.1%), and complications (1.8% vs 9.1%). In aspiration-only cases, the BGC cohort had a significantly higher rate of first-pass effect (100% vs 50.0%, p=0.01). BGC was associated with a higher likelihood of achieving a modified Rankin Scale score of 2 at discharge (OR 7.76, p=0.02). No additional procedural time was required for BGC cases (46.7 vs 48.2 min).

Conclusion BGCs may be safely adopted with comparable procedural efficacy, benefits to aspiration-only techniques, and earlier functional improvement compared with conventional guide catheters.

  • Thrombectomy
  • Balloon
  • Stroke
  • Stent
  • Catheter

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Twitter @dylanwolman, @JeremyHeitMDPHD

  • Contributors NAT, DW, AVP, BP, and JJH conceived the presented idea and assisted with research design. NAT, LHK, JC, and JZ assisted with data collection and analysis, as well as manuscript preparation. All authors assisted with manuscript editing. NAT accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.

  • 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.

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