Comparison of balloon guide catheter versus non-balloon guide catheter for mechanical thrombectomy in patients with distal medium vessel occlusion

Atakan Orscelik, David F. Kallmes, Cem Bilgin, Basel Musmar, Yigit Can Senol, Hassan Kobeissi, Sameh Samir Elawady, Conor Cunningham, Hidetoshi Matsukawa, Sara Zandpazandi, Mohammad Mahdi Sowlat, Ilko Maier, Sami Al Kasab, Pascal Jabbour, Joon Tae Kim, Stacey Q. Wolfe, Ansaar Rai, Robert M. Starke, Marios Nikos Psychogios, Edgar A. SamaniegoAdam S. Arthur, Shinichi Yoshimura, Hugo Cuellar, Brian M. Howard, Ali Alawieh, Daniele G. Romano, Omar Tanweer, Justin Mascitelli, Isabel Fragata, Adam J. Polifka, Joshua W. Osbun, Roberto Javier Crosa, Charles Matouk, Min S. Park, Michael R. Levitt, Mark Moss, Travis M. Dumont, Richard Williamson, Pedro Navia, Peter Kan, Reade De Leacy, Shakeel A. Chowdhry, Mohamad Ezzeldin, Alejandro M. Spiotta, Waleed Brinjikji

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Several studies have established the safety and efficacy of balloon guide catheters (BGCs) for large vessel occlusions. However, the utility of BGCs remains largely unexplored for distal medium vessel occlusions (DMVOs). In this study, we aim to compare the outcomes of BGC vs. Non-BGC in patients undergoing mechanical thrombectomy (MT) for DMVO. Method: This retrospective study from the Stroke Thrombectomy and Aneurysm Registry (STAR) encompassed adult patients with acute anterior cerebral artery, posterior cerebral artery, and middle cerebral artery-M2-3-4 occlusions. Procedure times, safety, recanalization, and neurological outcomes were compared between the two groups, with subgroup analysis based on first-line thrombectomy techniques. Results: A total of 1508 patients were included, with 231 patients (15.3%) in the BGC group and 1277 patients (84.7%) in the non-BGC group. The BGC group had a lower modified Thrombolysis in Cerebral Infarction (mTICI) score ≥2C (43.2% vs 52.7%, P=0.01), longer time from puncture to intracranial access (15 vs 8 min, P<0.01), and from puncture to final recanalization (97 vs 34 min, P<0.01). In the Solumbra subgroup, the first pass effect (FPE) rate was lower in the BGC group (17.4% vs 30.7%, P=0.03). Regarding clinical outcomes, the BGC group had a lower rate of distal embolization (8.8% vs 14.9%, P=0.03). Conclusion: Our study found that use of BGC in patients with DMVO was associated with lower mTICI scores, decreased FPE rates, reduced distal embolization, and longer procedure times.

Original languageEnglish
Article number020925
JournalJournal of NeuroInterventional Surgery
StateAccepted/In press - 2023


  • Balloon
  • Stroke
  • Technology
  • Thrombectomy


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