Balancing flow arrest and aspiration: The relationship between balloon guide catheters, large-bore aspiration, and first pass effect in mechanical thrombectomy

BackgroundBalloon guide catheters (BGCs) have been associated with higher rates of first pass effect (FPE) in endovascular thrombectomy. Large-bore aspiration catheters (ACs) placed at the face of the embolus may mimic the flow arrest effect seen with BGCs; combined use and its effect on FPE have not been previously well-studied. This study aims to evaluate the impact of this dual-device strategy on achieving FPE.MethodsWe conducted a retrospective cohort study across three sites (2018-2024). A multicenter registry was queried for adult patients with anterior circulation acute ischemic stroke treated with thrombectomy. The primary outcome was rate of FPE (modified Treatment in Cerebral Infarction (mTICI) 2C/3 on the first pass). Multivariable logistic regressions for likelihood of FPE were performed.Results973 patients were included, with a median age of 69 years (IQR 59-79). BGCs were used in 26.3%. Large-bore ACs were used in 68.7%. In most cases, large-bore ACs were used without a BGC (BGC-: 77.5% vs. BGC+: 43.8%, <i>P</i> < .001). FPE was achieved in 3-0.6% of procedures. BGC usage was significantly associated with FPE (aOR: 1.94, 95% CI: 1.01-3.72, <i>P</i> = .04). When sub-stratified by BGC use, large-bore AC use was found to be significantly associated with FPE only when a BGC was not used (aOR: 3.34, 95% CI: 1.01-12.14, <i>P</i> = .04).ConclusionBGC use is associated with an increased likelihood of FPE; when BGCs were not used, large-bore ACs were significantly associated with a higher likelihood of FPE. These findings are important when considering which tools contribute to successfully achieving FPE.

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Journal
Interventional Neuroradiology
Published
2025-11-25
DOI
https://doi.org/10.1177/15910199251399457
Primary Topic
Acute Ischemic Stroke Management
Type
article
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article

Balancing flow arrest and aspiration: The relationship between balloon guide catheters, large-bore aspiration, and first pass effect in mechanical thrombectomy

Tudor G. Jovin, Nashwa Abdelhakim, Hamza A. Shaikh, Ahmad A. Ballout et al.
Interventional Neuroradiology
Acute Ischemic Stroke Management
article

Balancing flow arrest and aspiration: The relationship between balloon guide catheters, large-bore aspiration, and first pass effect in mechanical thrombectomy

Tudor G. Jovin, Nashwa Abdelhakim, Hamza A. Shaikh, Ahmad A. Ballout, Karol P. Budohoski, Santiago Ortega‐Gutiérrez, Jason Aubrey, Julian Brown, Ajith J. Thomas, Ramesh Grandhi, Daniel A. Tonetti, Jane Khalife, Edgar Andres Samaniego, Manisha Koneru, Diwas Gautam, Joshua Santucci, Craig Kilburg, Omid Shoraka, Parth Patel, Anderson Brito, Robert Charles Rennert, Douglas Brown, Leonardo Cruz‐Criollo
article en

Abstract

BackgroundBalloon guide catheters (BGCs) have been associated with higher rates of first pass effect (FPE) in endovascular thrombectomy. Large-bore aspiration catheters (ACs) placed at the face of the embolus may mimic the flow arrest effect seen with BGCs; combined use and its effect on FPE have not been previously well-studied. This study aims to evaluate the impact of this dual-device strategy on achieving FPE.MethodsWe conducted a retrospective cohort study across three sites (2018-2024). A multicenter registry was queried for adult patients with anterior circulation acute ischemic stroke treated with thrombectomy. The primary outcome was rate of FPE (modified Treatment in Cerebral Infarction (mTICI) 2C/3 on the first pass). Multivariable logistic regressions for likelihood of FPE were performed.Results973 patients were included, with a median age of 69 years (IQR 59-79). BGCs were used in 26.3%. Large-bore ACs were used in 68.7%. In most cases, large-bore ACs were used without a BGC (BGC-: 77.5% vs. BGC+: 43.8%, <i>P</i> < .001). FPE was achieved in 3-0.6% of procedures. BGC usage was significantly associated with FPE (aOR: 1.94, 95% CI: 1.01-3.72, <i>P</i> = .04). When sub-stratified by BGC use, large-bore AC use was found to be significantly associated with FPE only when a BGC was not used (aOR: 3.34, 95% CI: 1.01-12.14, <i>P</i> = .04).ConclusionBGC use is associated with an increased likelihood of FPE; when BGCs were not used, large-bore ACs were significantly associated with a higher likelihood of FPE. These findings are important when considering which tools contribute to successfully achieving FPE.

Interventional Neuroradiology
University of Utah (US), Spencer Foundation (US), University of Iowa Hospitals and Clinics (US), Cooper Medical School of Rowan University (US), University of Utah Health Care (US), Cooper University Health Care (US)
Openalex Percentile: Top 53%
Acute Ischemic Stroke Management
DOIOpen Access PDFOpenAlex
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