In-Vitro Comparison of Cyclic Aspiration and Superbore Aspiration Catheters to Conventional 6Fr Aspiration for LVO Stroke

Abstract

The aim was to compare conventional aspiration (CA) using 6Fr catheters with two emerging techniques: Superbore Aspiration Catheters (SAC), which have a 0.088″ lumen, and Cyclic Aspiration (CycA), which combines a 6Fr aspiration catheter with a cyclic pressure waveform, both aiming to improve revascularization and minimize distal embolization. Ovine blood clots (soft, mixed, stiff) were lodged in the ICA and M1 of an in-vitro thrombectomy model. A proprietary cyclic aspiration waveform was optimized. React 71 was used for the CA and CycA groups; Millipede88 was used for SAC. Key endpoints for assessing differences between techniques were First Pass Effect (FPE), Complete Clot Ingestion (CCI), Final Complete Revascularization (mTICI 2c/3 within three passes), and distal emboli rates. SAC had the highest rates of FPE (ICA; 32%, MCA; 88%) and Final Complete Revascularization (ICA; 91%, MCA; 91%). Compared to CA, CycA was associated with numerically higher rates of CCI (26% vs 9%) and FPE (29% vs 21%) in ICA occlusions. CycA had similar rates of CCI (62% vs 59%) and a lower rate of FPE (62% vs 71%) in MCA occlusions, compared to CA. CycA and CA had similar rates of Final Complete Revascularization (ICA; 79% vs 79%, MCA; 79% vs 82%). SAC had the least distal emboli in both MCA and ICA occlusions. CycA had the most distal emboli overall, particularly for ICA occlusions. SAC demonstrated superior revascularization performance in-vitro compared to CycA and CA, improving both FPE and Final Complete Revascularization. CycA was associated with higher observed rates of CCI and FPE in the ICA, but generated more distal emboli.