Impact of Balloon-Guided Catheter Position on First-Pass Effect in Mechanical Thrombectomy for Anterior Circulation...

The first-pass effect (FPE; complete or near-complete reperfusion [extended TICI 2b-3] after a single thrombectomy pass) is a key functional outcome determinant. This study identified factors associated with FPE and quantitatively evaluated how balloon-guided catheter (BGC) positioning relates to FPE achievement during anterior circulation mechanical thrombectomy.

We retrospectively analyzed a prospectively maintained database of consecutive patients with anterior circulation large vessel occlusion who underwent mechanical thrombectomy using a BGC between May 2022 and February 2025. The BGC tip to the proximal petrous ICA distance was measured using lateral angiography at the initial BGC position. Factors associated with FPE were evaluated using univariate and multivariate logistic regression analyses. Receiver operating characteristic curve analysis determined the optimal cutoff value for predicting FPE.

Among 110 patients (median age, 81 years; 54% men), 56% achieved FPE. A shorter BGC tip to proximal petrous ICA distance was independently associated with higher FPE rates (adjusted OR, 0.96; 95% CI, 0.94-0.98; P < .001). Greater distance correlated with longer procedure time (r = 0.3; P < .001) and more thrombectomy passes (P < .001). Receiver operating characteristic analysis identified 24 mm as the optimal cutoff (area under the curve, 0.7). Distal BGC positioning was associated with fewer distal emboli and shorter recanalization time without serious complications.

Distal BGC placement within 24 mm of the proximal petrous ICA independently predicted higher FPE achievement and greater procedural efficiency. Quantitative BGC position assessment may provide a practical intraoperative metric to optimize mechanical thrombectomy strategies.