Journal article
Balancing flow arrest and aspiration: The relationship between balloon guide catheters, large-bore aspiration, and first pass effect in mechanical thrombectomy
Interventional neuroradiology
11/25/2025
DOI: 10.1177/15910199251399457
PMCID: PMC12646947
PMID: 41289187
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%,
< .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,
= .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,
= .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.
Details
- Title: Subtitle
- Balancing flow arrest and aspiration: The relationship between balloon guide catheters, large-bore aspiration, and first pass effect in mechanical thrombectomy
- Creators
- Danielle C Brown - Cooper Medical School of Rowan UniversityManisha Koneru - Cooper University Health CareJane Khalife - Cooper University Health CareHamza A Shaikh - Cooper University Health CareJoshua Santucci - Cooper University Health CareAhmad A Ballout - Cooper University Health CarePratit D Patel - Cooper University Health CareKarol Budohoski - University of UtahCraig Kilburg - University of UtahRobert C Rennert - University of UtahOmid Shoraka - University of UtahDiwas Gautam - University of UtahJackson Aubrey - University of UtahJulian Brown - University of UtahLeonardo Cruz-Criollo - University of IowaNashwa Abdelhakim - University of IowaAnderson Brito - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USAAjith J Thomas - Cooper University Health CareTudor G Jovin - Cooper University Health CareEdgar A Samaniego - University of IowaSantiago Ortega-Gutierrez - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USARamesh Grandhi - University of UtahDaniel A Tonetti - Cooper University Health Care
- Resource Type
- Journal article
- Publication Details
- Interventional neuroradiology
- DOI
- 10.1177/15910199251399457
- PMID
- 41289187
- PMCID
- PMC12646947
- NLM abbreviation
- Interv Neuroradiol
- ISSN
- 1591-0199
- eISSN
- 2385-2011
- Publisher
- Sage
- Language
- English
- Electronic publication date
- 11/25/2025
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9985034934102771
Metrics
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