{
  "abstract": "Background The use of balloon guide catheter (BGC) has been associated with better reperfusion and clinical outcomes in mechanical thrombectomy (MT) for large vessel occlusion stroke. However, the impact of BGC on angiographic and clinical outcomes in patients with distal medium vessel occlusion (DMVO) strokes undergoing MT has not been extensively investigated.Methods This is a retrospective analysis of a prospectively collected database from 14 comprehensive stroke centers in the United States and Europe. Patients with anterior circulation DMVO due to middle cerebral artery (MCA) M3/M4 or anterior cerebral artery (ACA) A1/A2-3 were included. The cohort was divided into BGC and non-BGC groups. Multivariable logistic regression and inverse probability of treatment weighting (IPTW) were used for comparison. The primary outcome was first pass effect (FPE) defined as modified treatment in cerebral infarction (mTICI) grade 2C/3 after single device pass.Results Among 199 patients who were eligible for analysis, 81 (40.7%) were female. The median age was 69 (60-81) years, and National Institutes of Health Stroke Scale score was 13 (7–18). The BGC group (n=73) had higher rates of FPE (53.4% vs 13.7%; IPTW aOR 5.63, 95%CI (2.43 to 13.10), P<0.001) compared with the non-BGC group (n=126). The BGC group had higher rates of modified Rankin Scale (mRS) 0-1 (42.9% vs 27.1%; IPTW aOR 2.78, 95% CI (1.10 to 7.07), P=0.031), mRS 0-2 (60.3% vs 41.5%; IPTW aOR 4.31, 95% CI (1.66 to 11.19), P=0.003), and lower rates of mortality at 90-days (12.7% vs 25.4%; IPTW aOR 0.32, 95% CI (0.11 to 0.98), P=0.047) compared with the non-BGC group. The rates of successful reperfusion at the end of the procedure and symptomatic intracerebral hemorrhage were comparable between both groups.Conclusion The present study suggests that the use of BGC in DMVO undergoing MT may be associated with improved angiographic and clinical outcomes with no safety concerns. Prospective studies are warranted.",
  "authors": [
    {
      "affiliations": [
        "Grady Memorial Hospital, Atlanta, Georgia, USA",
        "Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA",
        "Department of Neurology, South Valley University Faculty of Medicine, Qena, Egypt"
      ],
      "name": "Mahmoud H Mohammaden"
    },
    {
      "affiliations": [
        "Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Mohamed F Doheim"
    },
    {
      "affiliations": [
        "Grady Memorial Hospital, Atlanta, Georgia, USA",
        "Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA"
      ],
      "name": "Jaydevsinh Dolia"
    },
    {
      "affiliations": [
        "Grady Memorial Hospital, Atlanta, Georgia, USA",
        "Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA"
      ],
      "name": "Hend Abdelhamid"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA"
      ],
      "name": "Stavros Matsoukas"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA"
      ],
      "name": "Braxton Riley Schuldt"
    },
    {
      "affiliations": [
        "Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA"
      ],
      "name": "Johanna T Fifi"
    },
    {
      "affiliations": [
        "Department of Neurology, Neurosurgery, UPMC, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Okkes Kuybu"
    },
    {
      "affiliations": [
        "Department of Neurology, Neurosurgery, UPMC, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Alhamza R Al-Bayati"
    },
    {
      "affiliations": [
        "Department of Neurology, Vall d’Hebron University Hospital, Stroke Unit, Barcelona, Spain"
      ],
      "name": "Marta Olive Gadea"
    },
    {
      "affiliations": [
        "Department of Neurology, Vall d’Hebron University Hospital, Stroke Unit, Barcelona, Spain"
      ],
      "name": "Marc Rodrigo-Gisbert"
    },
    {
      "affiliations": [
        "Department of Neurology, Vall d’Hebron University Hospital, Stroke Unit, Barcelona, Spain"
      ],
      "name": "Manuel Requena"
    },
    {
      "affiliations": [
        "Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"
      ],
      "name": "Andre Monteiro"
    },
    {
      "affiliations": [
        "Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA"
      ],
      "name": "Adnan Siddiqui"
    },
    {
      "affiliations": [
        "Grady Memorial Hospital, Atlanta, Georgia, USA",
        "Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA"
      ],
      "name": "Felipe Ferreira"
    },
    {
      "affiliations": [
        "Department of Neurology, South Valley University Faculty of Medicine, Qena, Egypt"
      ],
      "name": "Ayman Gamea"
    },
    {
      "affiliations": [
        "Cooper Medical School of Rowan University, Camden, New Jersey, USA"
      ],
      "name": "Siyuan Yu"
    },
    {
      "affiliations": [
        "Cooper Neurological Institute, Cooper University Health Care, Camden, New Jersey, USA"
      ],
      "name": "James E Siegler"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA"
      ],
      "name": "Milagros Galecio-Castillo"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA"
      ],
      "name": "Leonardo Cruz-Criollo"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA"
      ],
      "name": "Santiago Ortega-Gutierrez"
    },
    {
      "affiliations": [
        "Neurosurgery, Lyerly Neurosurgery, Jacksonville, Florida, USA"
      ],
      "name": "Gustavo M Cortez"
    },
    {
      "affiliations": [
        "Neurosurgery, Lyerly Neurosurgery, Jacksonville, Florida, USA"
      ],
      "name": "Ricardo A Hanel"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA"
      ],
      "name": "Ameer E Hassan"
    },
    {
      "affiliations": [
        "Neurology, Boston University School of Medicine, Boston, Massachusetts, USA"
      ],
      "name": "Thanh N Nguyen"
    },
    {
      "affiliations": [
        "Radiology, Boston Medical Center, Boston, Massachusetts, USA"
      ],
      "name": "Mohamad Abdalkader"
    },
    {
      "affiliations": [
        "Neurology, Radiology, Boston University School of Medicine, Boston, Massachusetts, USA"
      ],
      "name": "Piers Klein"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Mohamed M Salem"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Jan-Karl Burkhardt"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Brian Jankowitz"
    },
    {
      "affiliations": [
        "Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA"
      ],
      "name": "Marco Colasurdo"
    },
    {
      "affiliations": [
        "Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA"
      ],
      "name": "Peter Kan"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA"
      ],
      "name": "Muhammad Hafeez"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA"
      ],
      "name": "Omar Tanweer"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA"
      ],
      "name": "Sophia Peng"
    },
    {
      "affiliations": [
        "Neurosurgery and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA"
      ],
      "name": "Jonathan A Grossberg"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA"
      ],
      "name": "Ali Alaraj"
    },
    {
      "affiliations": [
        "Department of Neurology, Neurosurgery, UPMC, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Raul G Nogueira"
    },
    {
      "affiliations": [
        "Grady Memorial Hospital, Atlanta, Georgia, USA",
        "Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA"
      ],
      "name": "Diogo C Haussen"
    }
  ],
  "title": "Balloon guide catheter impact on angiographic and clinical outcomes in distal medium vessel occlusion stroke thrombectomy",
  "uid": "271e24f1-47cb-5fa7-abb4-0859b5f132d1"
}