RT Journal Article SR Electronic T1 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 JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP 863 OP 867 DO 10.1136/neurintsurg-2021-017760 VO 14 IS 9 A1 Jordi Blasco A1 Josep Puig A1 Antonio López-Rueda A1 Pepus Daunis-i-Estadella A1 Laura Llull A1 Federico Zarco A1 Napoleon Macias A1 Juan Macho A1 Eva González A1 Ion Labayen A1 Pedro Vega A1 Eduardo Murias A1 Elvira Jimenez-Gomez A1 Isabel Bravo Rey A1 Manuel Moreu A1 Carlos Pérez-García A1 Oscar Chirife Chaparro A1 Sonia Aixut A1 Mikel Terceño A1 Mariano Werner A1 José Manuel Pumar A1 Yeray Aguilar Tejedor A1 Jose Carlos Mendez A1 Sarai Moliner A1 Raul G Nogueira A1 Luis San Roman A1 , YR 2022 UL http://jnis.bmj.com/content/14/9/863.abstract AB 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.