Introduction/Purpose Aspiration thrombectomy is one of the standard approaches for treatment of AIS secondary to large vessel occlusion and was proved to be equivalent to stent-retriever thrombectomy in terms of vessel recanalization and patient clinical outcomes. Aspiration thrombectomy using super large-bore catheters showed high rates of complete clot ingestion which minimizes the risk of distal emboli. The 0.088-inch HiPoint catheter is delivered to the face of the clot over the Tenzing 8, which almost completely occupies its inner lumen. This design markedly reduces the ledge between the two catheters. Withdrawal of the Tenzing catheter creates a vacuum based on the law of conservation of mass which results in the 0.088-inch catheter sliding slightly forward and ingesting the clot as a whole. The super large-bore catheter is then withdrawn while aspirating through the Base Camp and HiPoint catheters as a single assembly. We here report our 2-year single center stroke thrombectomy experience with this triaxial catheter assembly.

Materials and Methods Retrospective review of our comprehensive stroke center database between February 2021 and February 2023. We then identified all patients with large vessel occlusions on pre-procedural cross-sectional imaging who underwent first line aspiration thrombectomy using the 0.088-inch super large-bore catheter. Clinical and procedural data was collected.

Results We identified 36 patients (20 females) with mean age of 70 years (range 30-101) who were found to have with intracranial large vessel occlusions, either ICA terminus or supraclinoid ICA (n=13) or M1/MCA (n=23). Median baseline mRS was 0 (range 0-4) and presenting mean NIHSS was 19 (range 1-34). ASPECTS scores were 7-10 in 27 patients and 5 or less in 3 patients. Imaging was not available in 2 patients. Ten patients received IV thrombolysis. The 0.088-inch HiPoint catheter was successfully advanced to the site of occlusion in all cases. Twenty-six cases were successfully treated with the 0.088-inch catheter alone. Single pass mTICI 2C and 3 was achieved in 22 cases. Two-pass thrombectomy resulted in mTICI 2C or 3 in 3 cases. All cases achieved mTICI ≥2B. In this subgroup, mean time from groin puncture to first pass was 16 minutes (range 6-31 minutes) and mean time from puncture to recanalization was 22 minutes (range 13-36 minutes). In the remaining 10 cases, the 0.088-inch catheter was used as the first line treatment approach but additional passes with other catheters/devices were needed to achieve successful reperfusion mTICI≥2B. Median number of passes was 2.5 (range 2-4) witch excellent reperfusion achieved in 5 cases (50% of subgroup). mTICI ≥2B was achieved in all cases. In this subgroup, mean time from groin puncture to first pass was 14 minutes (range 10-21 minutes) and mean time from puncture to recanalization was 51 minutes (range 33-76 minutes). Overall excellent reperfusion was achieved in 25 cases (75%). One self-limiting active extravasation was encountered without clinical sequala. No procedure-related symptomatic intracranial hemorrhage occurred.

Conclusion Navigation of the super large-bore aspiration catheter extender over the Tenzing insert was successful and safe. First-pass effect with mTICI≥2B was achieved in 64.3% and mTICI≥2C in 57.1%.

Disclosures A. Kuhn: None. J. Singh: None. S. Sarid: None. M. Garcia: None. A. Puri: 1; C; NIH, Microvention, Cerenovus, Medtronic Neurovascular and Stryker Neurovascular. 2; C; Medtronic Neurovascular, Stryker NeurovascularBalt, Q’Apel Medical, Cerenovus, Microvention, Imperative Care, Agile, Merit, CereVasc and Arsenal Medical. 4; C; InNeuroCo, Agile, Perfuze, Galaxy and NTI.