Introduction Direct aspiration thrombectomy with super large-bore catheters (SLBC, 0.088’ ID) may improve first pass reperfusion, though consistent delivery to the target occlusion is difficult. We report our multicenter initial experience with a novel full length SLBC (Route 92 Medical Freeclimb 088 catheter, currently approved for neurovascular access), and its customized Tenzing 8 delivery catheter, for supraclinoid (SCICA) and middle cerebral artery M1 (M1) occlusions.

Methods We performed a retrospective review of aspiration thrombectomy cases performed at three stroke centers from May 2022 through November 2022. All patients were treated using the Route 92 Medical Basecamp guide catheter, Freeclimb 88 catheter and Tenzing 8 delivery catheter in an off-label fashion.

Results Fourteen consecutive acute stroke patients with SCICA or M1 LVOs underwent aspiration thrombectomy using the Freeclimb 88 and its Tenzing 8 delivery catheter. The median age was 74 (45-91) and 9 were female (64%). The median presenting NIHSS score and ASPECT score were 15 (8-24) and 9 (6-10), respectively. LVO locations were 3 right SCICAs, 6 right M1s and 5 left M1s. Three patients also had tandem occlusion/near-occlusion of the cervical internal carotid artery. The Freeclimb 88 catheter was delivered to the target occlusion with the Tenzing 8 delivery catheter in 13/14 patients (93%); in one patient a stent retriever was required for delivery to the M1 occlusion. The median time from groin puncture to catheter delivery to the target occlusion was 14 minutes (7-35). First pass reperfusion (modified Thrombolysis in Cerebral Infarction score, mTICI) of 2B/2C/3 was achieved in 13/14 (93%) and of 2C/3 in 12/14 (86%) patients. Adjunctive therapy for a residual M2 occlusion was utilized in 2/14 patients. There were no adverse events or post-procedural symptomatic hemorrhages.

Conclusions Our initial experience with a novel full length SLBC (Route 92 Freeclimb 88 catheter) and its customized catheter delivery device (Tenzing 8) for aspiration thrombectomy of SCICA and M1 LVOs demonstrated successful delivery to the target occlusions in 93% of patients, with first pass mTICI 2c/3 achieved in 86%. No significant adverse events were noted.

Disclosures J. English: 2; C; Route 92 Medical. 4; C; Route 92 Medical (Co-Founder and Equity Holder). J. Caldwell: None. J. Singh: None. S. Lee: None. W. Kim: 2; C; Route 92 Medical. 4; C; Route 92 Medical (Equity Holder). F. Settecase: 2; C; Route 92 Medical. A. Puri: None.