A335 ‘Larger is not always better’ – comparing cyclical and static aspiration in a neurovascular flow model

Introduction Endovascular treatment with 0.088’ catheters and cyclical aspiration (CyA) may improve procedural outcomes in ischemic stroke patients.Aim of Study To evaluate the safety and efficacy of different aspiration patterns and catheter sizes in a neurovascular model with physiological flow.Method The middle cerebral artery (MCA-M1; proximal diameter = 3.5 mm, distal = 2.2 mm) was embolized using 40 friable (Length = 8.28 ± 0.16 mm) and 40 stiff clot analogs (Length = 5.29 ± 0.12 mm). CyA and static aspiration (StA) were tested with 0.071’ and 0.088’ catheters across four arms: CyA 71, CyA 88, StA 71, and StA 88. Endpoints included First Pass Recanalization rate (FPR%), distal embolization, and vessel collapse.Abstract A335 Figure 1Results Overall FPR was 65% (52/80), with CyA outperforming StA (FPR: 80% vs. 50%, p=0.005). FPR was lower with friable clots (55% vs. 75%, p=0.061). CyA 71 achieved higher FPR (85%) compared to StA 71 and StA 88 (both 50%, p=0.054). For stiff clots, CyA 71 (100%) and CyA 88 (80%) were superior to StA 88 (30%) (p=0.019 and p=0.037, respectively). Vessel collapse reduced FPR (69% vs. 41%; p=0.066). The 0.071’ catheter did not cause collapse. With 0.088’ catheters, collapse was less frequent with CyA (CyA 88: 10% vs. StA 88: 70%, p=0.044). No differences were found in distal embolization rates.Abstract A335 Figure 2Conclusion Large bore catheters enhance recanalization unless vessel collapse occurs. Cyclical aspiration reduces vessel collapse and improves clot retrieval efficacy without increasing distal embolization.Conflict of Interest No