• Josep Puig, Mariano Werner, Guillem Dolz, Alejandro Pascagaza, Pepus Daunis-I-Estadella, Marc Comas-Cufí, Eva González, Jon Fondevila, Pedro Vega, Eduardo Murias, Veredas Romero, Carlos Martínez, Fernando Aparici-Robles, Lluis Morales-Caba, Sebastià Remollo, Isabel Rodríguez-Caamaño, Carlos Pérez-García, Santiago Rosati, Saima Bashir, Isabel Vielba-Gomez, Sonia Aixut, Andrés Julian Paipa, Javier Martínez-Fernández, Yeray Aguilar, Eduardo Fandiño, Giorgio Barbieri, Blanca García-Villalba, Víctor Cuba, Miguel Castaño, Jordi Blasco, and ROSSETTI Group.
• Radiology Department CDI, Hospital Clinic of Barcelona and IDIBAPS, Barcelona, Spain.
• J Neuroimaging. 2025 Jan 1; 35 (1): e70012e70012.

Background And PurposeThe safety and effectiveness of endovascular techniques in elderly patients with large vessel occlusion (LVO) remain controversial. We investigated the angiographic and clinical outcomes of nonagenarians treated with different endovascular techniques using a balloon guide catheter (BGC), distal aspiration catheter (DAC), and/or stent retriever (SR).MethodsWe analyzed the data from the Registry of Combined versus Single Thrombectomy Techniques (ROSSETTI) of consecutive nonagenarian patients with anterior circulation LVO and compared the outcomes of those treated with BGC+noDAC+SR (101-group), BGC+DAC+SR (111-group), and noBGC+DAC+SR (011-group). Demographic, clinical, angiographic, and clinical outcome data (National Institute of Health Stroke Scale score at 24 h [24h-NIHSS] and modified Rankin Scale score at 3 months) were compared. Predictors of the first-pass effect (FPE), defining Modified Treatment In Cerebral Ischemia 2c-3 (mTICI 2c-3) after one pass, were explored.ResultsOf the 4111 patients from the ROSSETTI registry, 243 nonagenarians (68.7% female) were included in the analysis. The distribution of endovascular techniques was 101-group (61.4%), 111-group (15.6%), and 011-group (23%). The 101-group and 111-group had significantly shorter procedural times than the 011-group. The 111-group had a higher FPE rate, a lower number of passes, and a higher rate of final mTICI ≥2c than the other groups. The 24h-NIHSS score was significantly lower in the 111-group. In multivariate analysis, the only independent predictor for FPE was the BGC+DAC+SR endovascular technique (odds ratio 2.74 [confidence interval 1.16-6.47]; p = 0.021).ConclusionsThe addition of a DAC to a BGC increases the likelihood of FPE in nonagenarians with anterior circulation LVO SR-based thrombectomy for acute stroke.© 2025 The Author(s). Journal of Neuroimaging published by Wiley Periodicals LLC on behalf of American Society of Neuroimaging.

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