From the Mercy Health St. Vincent Mercy Hospital, Toledo, OH (O.O.Z.)Advanced Neuroscience Network/Tenet South Florida, Coral Springs (N.H.M.-K., R.K.)Valley Baptist Medical Center, Harlingen, TX (A.E.H.)Emory University School of Medicine, Atlanta, GA (D.C.H.)Grady Memorial Hospital, Atlanta, GA (D.C.H., R.G.N.)University of Pittsburgh Medical Center, PA (A.P.J.)Vanderbilt University Medical Center, Nashville, TN (M.T.F., R.C.)University of California, Los Angeles, CA (R.J., J.L.S., S.S., D.S.L.)Brigham and Women’s Hospital, Boston, MA (M.A.A-S.)Methodist Hospital, Houston, TX (R.P.K.)Florida Hospital Neuroscience Institute, Winter Park (F.R.H., R.H.G.)University of Miami Miller School of Medicine/Jackson Memorial Hospital, FL (D.R.Y., E.C.P.)Norton Neuroscience Institute, Norton Healthcare, Louisville, KY (T.L.Y., S.D.)WellStar Neurosciences Network, WellStar Kennestone Regional Medical Center, Marietta, GA (R.G.)St. Luke’s Hospital of Kansas City, MO (C.O.M.)Oregon Health and Science University Hospital, Portland (H.B.)Baptist Health Lexington/Central Baptist, KY (C.A.G.)South Broward Hospital, Hollywood, FL (B.P.M.)Providence St. Vincent Medical Center, Portland, OR (V.D.)Baptist Hospital of Miami, FL (I.L.)St. Dominic’s–Jackson Memorial Hospital, MS (S.H.M.)University of Tennessee Medical Center, Knoxville (P.K.)Advocate Christ Medical Center, Oak Lawn, IL (T.J.G.)Cleveland Clinic, OH (M.S.H.)Baylor University Medical Center, Dallas, TX (I.T.)OhioHealth Riverside Methodist Hospital, Columbus (N.V.)Memorial Hermann Texas Medical Center, Houston (P.R.C.)Swedish Medical Center First Hill Campus, Seattle, WA (S.J.M.)Maine Medical Center, Portland, ME (R.D.E.)Geisinger Clinic, Danville, PA (C.M.S.)Baptist Medical Center Jacksonville, FL (E.S.)Baptist Hospital Louisville, KY (A.B.C.)Barnes Jewish Hospital, St. Louis, MO (C.P.D.)Mercy San Juan Medical Center and Mercy General, Carmichael, CA (L.M.)Presence St. Joseph Medical Center, Joliet, IL (A.B.)Buffalo General Medical Center, NY (A.H.S.)University of Arizona Medical Center, Tucson (T.M.D.)University of Kentucky Hospital, Lexington (A.A.)Los Robles Medical Center, Thousand Oaks, CA (M.A.T.)Aurora Hospital, Milwaukee, WI (K.A.)West Virginia University/Ruby Memorial Hospital, Morgantown (J.C.)Albany Medical Center, NY (A.B.)University of Maryland Medical Center, Baltimore (G.J.)University of Massachusetts Memorial Medical Center, Worcester (A.S.P.)Crouse Hospital, Syracuse, NY (E.M.D.)Virginia Mason Medical Center, Seattle, WA (D.R.)Mayo Clinic, Rochester, MN (D.F.K.)Erlanger Medical Center, Chattanooga, TN (B.W.B.)ProMedica Toledo Hospital, OH (M.J.)Banner University Medical Center, Phoenix, AZ (P.S.)McLaren Flint, MI (A.M.)California Pacific Medical Center, San Francisco (J.D.E.)University of California, Irvine (S.S.)St. John Providence Hospital, Detroit, MI (R.D.F.)Abbott Northwestern Hospital, Minneapolis, MN (J.D-A.)and Carolinas Medical Center, Charlotte, NC (J.C.M.).
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Background and Purpose—Mechanical thrombectomy has been shown to improve clinical outcomes in patients with acute ischemic stroke. However, the impact of balloon guide catheter (BGC) use is not well established.Methods—STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) was a prospective, multicenter study of patients with large vessel occlusion treated with the Solitaire stent retriever as first-line therapy. In this study, an independent core laboratory, blinded to the clinical outcomes, reviewed all procedures and angiographic data to classify procedural technique, target clot location, recanalization after each pass, and determine the number of stent retriever passes. The primary clinical end point was functional independence (modified Rankin Scale, 0–2) at 3 months as determined on-site, and the angiographic end point was first-pass effect (FPE) success rate from a single device attempt (modified Thrombolysis in Cerebral Infarction, ≥2c) as determined by a core laboratory. Achieving modified FPE (modified Thrombolysis in Cerebral Infarction, ≥2b) was also assessed. Comparisons of clinical outcomes were made between groups and adjusted for baseline and procedural characteristics. All participating centers received institutional review board approval from their respective institutions.Results—Adjunctive technique groups included BGC (n=445), distal access catheter (n=238), and conventional guide catheter (n=62). The BGC group had a higher rate of FPE following first pass (212/443 [48%]) versus conventional guide catheter (16/62 [26%]; P=0.001) and distal access catheter (83/235 [35%]; P=0.002). Similarly, the BGC group had a higher rate of modified FPE (294/443 [66%]) versus conventional guide catheter (26/62 [42%]; P<0.001) and distal access catheter (129/234 [55%]; P=0.003). The BGC group achieved the highest rate of functional independence (253/415 [61%]) versus conventional guide catheter (23/55 [42%]; P=0.007) and distal access catheter (113/218 [52%]; P=0.027). Final revascularization and mortality rates did not differ across the groups.Conclusions—BGC use was an independent predictor of FPE, modified FPE, and functional independence, suggesting that its routine use may improve the rates of early revascularization success and good clinical outcomes.Clinical Trial Registration—URL: https://www.clinicaltrials.gov. Unique identifier: NCT02239640.