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Introduction Contact aspiration (ADAPT) and combined stent-retriever and aspiration (CAPTIVE) are common mechanical thrombectomy (MT) techniques for treatment of large-vessel occlusive acute ischemic stroke (LVO-AIS), but optimal first-line technique and equipment choices remain debated. 1-3 We sought to evaluate differences in technical effectiveness over a decade of evolving MT practice at a single center with progressive generations of aspiration catheters for both ADAPT and CAPTIVE, hypothesizing that newer-generation catheters will achieve superior first-pass efficacy (FPE).Materials and Methods We retrospectively reviewed a prospectively maintained thrombectomy registry at our comprehensive stroke center from 2/2015-7/2025. Consecutive patients with LVO-AIS involving the ICA terminus, M1 and proximal M2 MCA segments, basilar artery, or P1 PCA segment were included. Tandem or distal occlusions were excluded. Equipment choice and first-pass technique were at the discretion of seven operating neurointerventionalists. We included aspiration catheters categorized as ‘large’ (6-French equivalent) and recorded catheter type, technique, and mTICI per pass. The primary outcome measure was FPE (mTICI 2c-3 on first pass). Secondary outcomes included modified FPE (mFPE; mTICI 2b-3 on first pass), adequate (mTICI 2b-3) or excellent (mTICI 2c-3) final reperfusion, total number of passes, crossover to alternative techniques, and 90-day modified Rankin Scale (mRS).Results Among 3,669 MT cases, 1,926 were included (mean age: 72.0±14.8, 51.5% female). Among large aspiration catheters (n=1,330), FPE was not significantly more likely for first-pass CAPTIVE technique compared to ADAPT (p=0.184). However, mFPE was significantly more likely when using CAPTIVE as the first-line technique (p=0.026). Among large aspiration catheters, irrespective of first-line technique, the 6F-Sofia outperformed previous generation and contemporary catheters in achieving FPE (OR 1.46, 95%CI [1.19, 1.79]; p=0.002). Furthermore, the 6F-Sofia was associated with increased odds of achieving excellent final reperfusion (OR 4.38, 95%CI [3.38, 5.67]; p<0.001). A significant catheter-technique interaction was present for FPE (P=0.049). The 6F-Sofia achieved significantly higher likelihood of FPE with first-pass ADAPT than CAPTIVE (P=0.015), whereas the Catalyst 6 achieved higher likelihood of FPE with first-pass CAPTIVE than ADAPT (P=0.029). Crossover from first-pass ADAPT to second-pass CAPTIVE demonstrated improved likelihood of achieving excellent reperfusion on the second pass (p=0.002). While 90d-mRS was not significantly different by technique or equipment selection, it remained relatively flat despite more inclusive selection criteria over time (slope = 0.044, mean = 3.47).Conclusion Within our 10-year cohort, we found that more deliverable catheters and use of CAPTIVE was associated with an increased likelihood of FPE.Disclosures D. Hong: None. R. Kim: None. G. Karayi: None. E. Shaaya: None.Abstract O-003 Figure 1