{
  "abstract": "Introduction/Purpose The EXCELLENT registry is a prospective multicenter, global registry of endovascular stroke treatment using EMBOTRAP device with angiographic outcomes assessed by an independent core lab. This analysis evaluated if balloon guide catheter (BGC) use was associated with improved angiographic and clinical outcomes.Materials and Methods This post-hoc analysis of EXCELLENT registry included patients with acute internal carotid artery and proximal middle cerebral artery M1 occlusion. They were divided into those who underwent endovascular treatment with a BGC as the primary guide catheter vs those treated with traditional non-balloon guide catheter (non-BGC). Outcomes compared between groups included rate of first pass reperfusion (FPR) mTICI≥2c-3, final successful reperfusion (mTICI≥2b), and 90-day functional independence (modified Rankin score 0-2 or no worsening from baseline).Results This analysis included 492 patients-275 in the BGC group and 217 in non-BGC group. The non-BGC group included more radial access (8.8% vs 0.7%) and more frequent use of intermediate catheters (92.6% vs 61.1%) in the first pass. The BGC group had higher rates of FPR (42.3% vs 33.0%, p=0.038), final successful reperfusion (97.1% vs 93.0%, p=0.036) and final mTICI≥2c (69.6% vs 59.1%, p=0.016). On the multivariable analysis BGC was an independent predictor of FPR (OR 2.3297, 95% CI 1.4644-3.7063, p<0.001). There was no significant difference in 90-day functional independence (43.8% vs 45.2%, p=0.76).Conclusion In EXCELLENT the use of BGC was an independent predictor of FPR and was associated with higher rates of first pass and final reperfusion. However, there was no evidence of difference in the 90-day functional independence.Disclosures M. Waqas: None. R. Nogueira: 1; C; Anaconda Biomed, Astrocyte, Biogen, Brainomix, Cerebrotech, Johnson & Johnson MedTech Neurovascular, Ceretrieve, Corindus, Genentech, Hybernia, Imperative Care, Medtronic USA, NeuroVasc Technologies, Perfuze, Phenox, Philips, Prolong Pharmaceuticals, RapidPulse, Shanghai Wallaby, Stryker, Vesalio, Viz.ai. 4; C; Brain4Care, Brainomix, Cerebrotech, Ceretrieve, Corindus, Perfuze, Piraeus Medical, Quantanosis AI, Reist/Q’Apel, Truvic, Vesalio, Viseon, Viz.ai, Tulavi Therapeutics, Vastrax. 6; C; DUSK Trial PI, Synchron (DSMB). T. Andersson: 1; C; Anaconda, Johnson & Johnson MedTech Neurovascular, Ceretrieve, Optimize Neurovascular, Rapid Medical, SPRYTE, Cortirio. 4; C; Ceroflo. 6; C; Spryte Medical (ad hoc travel support). A. Yoo: 1; C; Medtronic, Johnson & Johnson MedTech Neurovascular, Penumbra, Stryker, Genentech, Balt. 2; C; Penumbra, Johnson & Johnson MedTech Neurovascular, Philips, Vesalio, NIH/NINDS, Rapid Medical, ZOLL Circulation, Nicolab, Route 92 Medical, Medtronic, Stryker, Genentech, Balt. 4; C; Insera Therapeutics, Galaxy Medical, Nicolab, Gravity Medical. 5; C; HCA Healthcare. 6; C; Nicolab (nonfinancial support for consulting), Zoll Circulation (nonfinancial support for consulting), NIH/NINDS (personal fees for serving as endovascular safety and data monitor), American Heart Association (editorial board), inSteps (Scientific Advisor/Advisory Board), HCA Neurovascular Research Advisory Board (Scientific Advisor/Advisory Board), Route 92 (Scientific Advisor/Advisory Board), Associate Editor of Stroke: Vascular and Interventional Neurology Journal, XCath (scientific advisory board). R. Hanel: 1; C; NIH, Interline Endowment, Microvention (now Terumo Neuro), Stryker Neurovascular, CNX. 2; C; Medtronic, Balt, Stryker, Q’Apel Medical, Johnson & Johnson MedTech Neurovascular, Terumo Neuro, Imperative Care, Phenox, Rapid Medical. 4; C; InNeuroCO, Cerebrotech, eLum, Endostream, Three Rivers, Scientia, Rist, BlinkTBI, Corindus. 6; C; MiVI (advisory board), eLum (advisory board), Three Rivers (advisory board), Shape Medical (advisory board), Corindus (advisory board). O. Zaidat: 1; C; Stryker, Medtronic, Johnson & Johnson MedTech Neurovascular, Penumbra, Genentech. 2; C; Johnson & Johnson MedTech Neurovascular, Medtronic, Stryker, Penumbra, National Institutes of Health (NIH) StrokeNet. 4; C; Galaxy Therapeutics, Penumbra. 6; C; National Institutes of Health StrokeNet Consortium (endovascular committee co-chair), Surpass and Pipeline embolization devices (proctor), PI for TESLA trial (grants from Medtronic, Stryker, Penumbra, Genentech, Johnson & Johnson MedTech Neurovascular), PI for PICASSO trial (received grants from Medtronic, Stryker, Penumbra), Stroke: Vascular and Interventional Neurology (editorial board), Patent holder. W. Hacke: 1; C; Boehringer Ingelheim. 2; C; Johnson & Johnson MedTech Neurovascular. T. Jovin: 1; C; National Institutes of Health, Patient-Centered Outcomes Research Institute, Medtronic, Stryker Neurovascular. 2; C; Johnson & Johnson MedTech Neurovascular, Contego Medical. 4; C; Anaconda, Route 92, Viz.ai, FreeOx, Methinks, Galaxy Therapeutics, AptaTargets, Kandu, Gravity, Luminopia, Carlsmed, StataDx, Vastrax, Let’s Get Proof, Baskin Biosciences. 6; C; Anaconda (advisor role), Viz.ai (advisor role), Route 92 (advisor role), FreeOx (advisor role), Methinks (advisor role), Galaxy Therapeutics (advisor role), AptaTargets (advisor role), Kandu (advisor role), Gravity (advisor role), Luminopia (advisor role), Carlsmed (advisor role), StataDx (advisor role), Vastrax (advisor role), Let’s Get Proof (advisor role), Johnson & Johnson MedTech Neurovascular (DSMB and steering committee - personal fees), Contego Medical (screening committee). J. Fiehler: 1; C; European Commission. 2; C; Acandis, Johnson & Johnson MedTech Neurovascular, Medtronic, Terumo Neuro, Phenox, Stryker, Roche. 4; C; Tegus Medical, Eppdata, Vastrax. 6; C; Philips (consulting – no payments), Penumbra (lectures, presentations, speakers bureaus, article writing, educational events, meeting/travel support), Tonbridge (lectures, presentations, speakers bureaus, article writing, educational events), Medtronic (support for attending meetings or travel), Past president of ESMINT, Phenox (DSMB/Advisory Board – personal fees), Stryker (DSMB/Advisory Board – personal fees). S. De Meyer: 6; C; Johnson & Johnson MedTech Neurovascular (travel support). A. Siddiqui: 1; C; Brain Aneurysm Foundation, National Institutes of Health, National Institute of Neurological Disorders and Stroke. 2; C; Amnis Therapeutics, Apellis Pharmaceuticals, Boston Scientific, Canon Medical Systems, Cardinal Health 200, Cerebrotech, Cerevatech, Cordis Neurovascular, Corindus, Endostream, Imperative Care, InspireMD, Integra LifeSciences, IRRAS AB, Johnson & Johnson MedTech Neurovascular, Medtronic, Terumo Neuro, Minnetronix Neuro, Peijia, Penumbra, Q’Apel, Rapid, Serenity, Silk Road, StimMed, Stryker, Three Rivers, VasSol, Viz.ai, W.L. Gore, Hyperfine Operations, Piraeus, Rebound Therapeutics, Abbott Labs, Asahi Intecc, Carotix, CerebrovaKP, Prometheus Therapeutics, ShockWave, Synchron Australia, Tegus, TG Medical, FreeOx Biotech, Hyperfine Operations, Vastrax, Vesalio, PerFlow. 4; C; Adona Medical, Amnis Therapeutics, Bend IT Technologies, BlinkTBI, Cerebrotech, Cerevatech, Cognition Medical, CVAID, E8, Endostream, Galaxy Therapeutics, Imperative Care, InspireMD, Instylla, International Medical Distribution Partners, Launch NY, Neurolutions, NeuroRadial Technologies (Sold to Medtronic in 2021), NeuroTechnology Investors, Neurovascular Diagnostics, Peijia Medical, PerFlow Medical, Q’Apel Medical, QAS.ai, Radical Catheter Technologies, Rebound Therapeutics (purchased by Integra LifeSciences), Rist Neurovascular (purchased by Medtronic), Sense Diagnostics, Serenity, Silk Road, Sim & Cure, SongBird Therapy, Spinnaker, StimMed, Synchron, Three Rivers, Truvic Medical, Tulavi Therapeutics, Vastrax, VICIS, Viseon, Buffalo Technology Partners, Cardinal Consultants, 3N Endovascular, Basecampv Vascular SAS, Borvo Medical, CerebrovaKP, Code Zero, Collavidence, Contego, FreeOx Biotech, Hyperion Surgical, Kandu Health, NextGen Biologics, Physician X, Piraeus, Prometheus Therapeutics, ReNiva, STENT’UP, TG Medical, Viz.ai, Whisper Medical, Willow Medtech, IRRAS, AB, Tegus Medical, PUMA Venture Capital Fund I. 5; C; University at Buffalo Neurosurgery and Jacobs Institute. 6; C; Society of NeuroInterventional Surgery (Board Secretary, 2020–2021), AANS/CNS Cerebrovascular Section (Chair, 2020–2021), Johnson & Johnson MedTech Neurovascular (EXCELLENT, NAPA, ARISE II Trials – leadership/steering roles, other services), Medtronic (SWIFT PRIME, VANTAGE, EMBOLISE, SWIFT DIRECT Trials), Terumo Neuro (FRED Trial, CONFIDENCE Study), MUSC (POSITIVE Trial), Penumbra (3D Separator, COMPASS, INVEST, TIGER Trials), MIVI Neuroscience (EVAQ Trial), Rapid Medical (SUCCESS Trial, other services), InspireMD (C-GUARDIANS IDE Pivotal Trial), Terumo Neuro (other services), MIVI (other services), Medical University of South Carolina (other services), Penumbra (other services), InspireMD (C-GUARDIANS IDE Pivotal Trial), Medtronic (other services), Cognition Medical (other services), Launch NY (other services), Neurovascular Diagnostics (other services), PUMA Venture Capital Fund (other services), Vastrax (other services), VICIS (other services), Brain Aneurysm Foundation (mentor), Joint Cerebrovascular Section of the American Association of Neurological Surgeons (past chair), Council of State Neurosurgical Societies, Society of Neurointerventional Surgery Standards and Guidelines Committee, Multispecialty Carotid Alliance, Northwest University–DSMB Chair for HEAT Trial, Patent holder.",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY"
      ],
      "name": "M Waqas"
    },
    {
      "affiliations": [
        "Neurology and Neurosurgery, University of Pittsburgh Medical Center (UPMC) Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA"
      ],
      "name": "R Nogueira"
    },
    {
      "affiliations": [
        "Neuroradiology, Karolinska University Hospital, Stockholm, Sweden"
      ],
      "name": "T Andersson"
    },
    {
      "affiliations": [
        "Texas Stroke Institute, Plano, TX"
      ],
      "name": "A Yoo"
    },
    {
      "affiliations": [
        "Baptist Neurological Institute, Jacksonville, FL"
      ],
      "name": "R Hanel"
    },
    {
      "affiliations": [
        "Mercy Health St. Vincent Medical Center, Toledo, OH"
      ],
      "name": "O Zaidat"
    },
    {
      "affiliations": [
        "Ruprecht Karl University of Heidelberg, Heidelberg, Germany"
      ],
      "name": "W Hacke"
    },
    {
      "affiliations": [
        "Cooper University Hospital, Camden, NJ"
      ],
      "name": "T Jovin"
    },
    {
      "affiliations": [
        "Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"
      ],
      "name": "J Fiehler"
    },
    {
      "affiliations": [
        "KU Leuven, Kortrijk, Belgium"
      ],
      "name": "S De Meyer"
    },
    {
      "affiliations": [
        "University at Buffalo Jacobs School of Medicine and Biomedical Sciences, NY, Buffalo, NY"
      ],
      "name": "A Siddiqui"
    }
  ],
  "title": "E-325 Balloon guide catheter as an independent predictor of first pass reperfusion: insights from the EXCELLENT registry",
  "uid": "1381f581-f13d-549b-95fe-df1354480c33"
}