Introduction Triaxial techniques combining a base catheter, aspiration catheter, and stent retriever, are widely employed in practice. Balloon guide catheters (BGC) for proximal flow control have been linked to improved outcomes, particularly with the modified first‐pass effect (mFPE). However, the impact of BGC‐induced flow arrest within triaxial systems on achieving mFPE is still unclear. This study aimed to evaluate whether the use of BGC in triaxial techniques is linked to mFPE. Methods We conducted a retrospective multicenter cohort of adults with anterior‐circulation large vessel occlusion (LVO) that underwent mechanical thrombectomy (2018‐2024) at three comprehensive stroke centers. Procedural first‐pass data and clinical/radiologic covariates were abstracted. We included patients were access used triaxial systems (base, aspiration, stent retriever) with or without a balloon guide catheter. The primary outcome was mFPE (TICI ≥2b after the first pass); FPE (TICI ≥2c) was a supportive outcome. Secondary outcomes were sICH, 90‐day functional independence (mRS 0‐2), and mortality. Multivariable logistic regression was performed, adjusting for baseline clinical and imaging covariates Results Of 1,102 patients, 497 met the inclusion. Median age was 69 years IQR 59‐78; 48.1% were women, and 24.9% architectures were triaxial+BGC (Table 1). We found no association for triaxial+BGC compared to triaxial alone for mFPE success (TICI≥2c: aOR 1.57, 95% CI 0.97‐2.52; p=0.065), FPE success (TICI≥2b: aOR 1.43, 0.89‐2.28; p=0.139), 90‐day functional independence (mRS 0‐2: aOR 0.85, 0.49‐1.44; p=0.553), and mortality (aOR 0.68, 0.32‐1.34; p=0.287). Alternatively, triaxial+BGC was associated with lower odds of sICH (aOR 0.47, 0.26‐0.84; p=0.013) (Table 2). Conclusion In anterior‐circulation LVO thrombectomy using triaxial techniques, BGC‐induced flow arrest was not associated with improved mFPE. A reduction in sICH was observed warranting further validation. Overall BGC may not enhance first‐pass reperfusion in this setting. image image
Amenábar et al. (Sat,) studied this question.