RT Journal Article
SR Electronic
T1 Balloon guide catheter improvements in thrombectomy outcomes persist despite advances in intracranial aspiration technology
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 773
OP 778
DO 10.1136/neurintsurg-2020-017027
VO 13
IS 9
A1 Jordi Blasco
A1 Josep Puig
A1 Pepus Daunis-i-Estadella
A1 Eva González
A1 Juan Jose Fondevila Monso
A1 Xabier Manso
A1 Rafael Oteros
A1 Elvira Jimenez-Gomez
A1 Isabel Bravo Rey
A1 Pedro Vega
A1 Eduardo Murias
A1 Jose Maria Jimenez
A1 Antonio López-Rueda
A1 Arturo Renú
A1 Sonia Aixut
A1 Oscar Chirife Chaparro
A1 Santiago Rosati
A1 Manuel Moreu
A1 Sebastian Remollo
A1 Yeray Aguilar Tejedor
A1 Mikel Terceño
A1 Antonio Mosqueira
A1 Raul G Nogueira
A1 Luis San Roman
YR 2021
UL http://jnis.bmj.com/content/13/9/773.abstract
AB 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.