EP47* Investigation of current and novel treatment strategies for ICA and MCA occlusions in an in-vitro thrombectomy model

Introduction Various mechanical thrombectomy devices and techniques including Stentrievers and Aspiration Catheters are used in the treatment of acute ischemic stroke.1Balloon Guide Catheters (BGC) are commonly used to achieve flow control. A new generation of ‘Super-bore’ 088’’ catheters are currently being tested clinically.2 3 Objective/Aim We evaluated the in-vitro revascularization performance of current and novel thrombectomy approaches. Methods National University of Ireland Galway Research Ethics Committee approved the study. Clot analogues from human blood were used to create ICA (20 mm) and MCA (10 mm) occlusions in an In-vitro thrombectomy model. Thrombectomy setups tested were; ADAPT: Millipede 088, SOFIA, SOFIA+BGC and Combination; Millipede 088+Solitaire, SOFIA+BGC+Solitaire, SOFIA+Solitaire. 10 replicates of each test were performed. Endpoints were First Pass Effect (FPE), Second and Third-pass success and procedural-related distal emboli from 50–1000µm. Results The Millipede 088 catheter achieved the highest rate of FPE in both ICA (60%) and MCA (100%) occlusions and had the lowest number of procedural-related emboli compared to all other device setups, followed by the Millipede 088+Solitaire technique. Of the currently used techniques, the use of a Solitaire in combination with a SOFIA lead to a higher rate of FPE in ICA occlusions (40% vs 20%, SOFIA+BGC+Solitaire vs SOFIA+BGC), but a lower rate of FPE in MCA occlusions (50% vs 60%, SOFIA+BGC+Solitaire vs SOFIA+BGC). Conclusions The novel 0.088’’ aspiration catheter achieves the best FPE rates in both ICA and MCA occlusions. In terms of existing techniques, ADAPT is more effective in the MCA, while the stentrievers provide a benefit in the ICA. References Hafeez MU, Kan P, Srivatsan A, Moore S, Jafari M, DeLaGarza C, et al. Comparison of first-pass efficacy among four mechanical thrombectomy techniques: a single-center experience. World Neurosurgery 2020;144:e533–e40. Gershon BS, Bageac DV, Shigematsu T, Majidi S, De Leacy R. Republished: first clinical report of aspiration through a novel 0.088-inch catheter positioned in the M1 middle cerebral artery for ELVO thrombectomy. Journal of NeuroInterventional Surgery 2021;13(4):e4–e. Nogueira RG, Mohammaden MH, Al-Bayati AR, Frankel MR, Haussen DC. Preliminary experience with 088 large bore intracranial catheters during stroke thrombectomy. Interventional Neuroradiology 2020:1591019920982219. Disclosure Sean Fitzgerald received research funding from Enterprise Ireland that is co-funded by Perfuze Ltd. Liam Mullins declares the following competing interest; Perfuze (stock options). John Thornton declares the following competing interests; Perfuze (Physician Advisory Board, stock options); Consultancy fees: Microvention, Johnson and Johnsons. Raul G. Nogueira declares the following competing interests: consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Imperative Care, Medtronic, Phenox, Prolong Pharmaceuticals, Stryker Neurovascular and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, and Perfuze.