Abstract 226: Combined Delivery Catheter Systems Aspiration‐First Approach For Stroke Thrombectomy: A Single Center experience
Authors: Fukuda K. A. , Blackwood M. , Peterson C. , Beaman C. , Turan N. , Molaie A. , Liebeskind D. , Sharma L. , Saver J. , Kaneko N. , Nour M. , Colby G. , Tateshima S. , Jahan R. , Duckwiler G. , Szeder V. 
Published: January 2025

Introduction
In acute ischemic stroke management, rapid reperfusion is critical to improving patient outcomes. Previous multicenter studies of the novel Tenzing delivery catheter, designed to simplify stroke thrombectomies, have demonstrated more streamlined procedures, faster delivery times and superior clinical outcomes.[1‐5] Now with three combined delivery catheter systems available—Route 92’s Tenzing‐Freeclimb 70, Penumbra's SENDit‐Red 72 and Q'Apel's Cheetah‐Hippo—there is potential for further advancement. However, data on the Penumbra and Q'Apel systems are currently lacking, and the combined performance of these devices is unknown. Our study aims to evaluate whether these systems improve reperfusion times, outcomes, and complication rates compared to our traditional aspiration thrombectomy approach in our institutional cohort.

Methods
We retrospectively analyzed prospectively collected data from June 2023 to July 2024, the period when these devices first became available for our use. We compared the outcomes of using the Tenzing, SENDit, and Cheetah combined delivery systems first approach with our typical aspiration‐first approach cases during the same period, commonly a Zoom 71 aspiration catheter, 0.021‐0.027” microcatheter and 0.014‐0.018”” microguidewire. Primary outcomes measured included first on clot time, device deployment, reperfusion times, reperfusion success, and incidence of symptomatic intracranial hemorrhage. Secondary analyses assessed total thrombectomy passes and fluoroscopy times.

Results
Seventy‐seven patients met the inclusion criteria with a mean age of 68.3 ± 15.7 years; 43% were female. Occlusion sites were M1 (59.7%), ICA terminus (16.8%), basilar or distal vertebral (10.3%), tandem ICA‐M1 (6.5%), and proximal M2 (6.5%). Microwires were not used in 5.2% of cases (n=4). The combined delivery systems (n=20; Penumbra=13, Route 92=4; Q'apel=3) showed significantly faster mean groin‐to‐on clot times (19.95 vs. 23.98 mins, p=0.03) compared to the traditional systems (n=57). The combined systems had faster mean groin‐to‐first device times (25.25 vs. 28.16 mins, p=0.13) and faster mean groin‐to‐reperfusion times (46.16 vs. 49.48 mins, p=0.58). Successful reperfusion (TICI≥2b) was significantly higher with the combined systems (95% vs. 71.9%, p=0.03). Notably, total fluoroscopy times were nominally lower (25.9 mins vs. 29.9 mins, p=0.45), and fewer mean number of passes (1.94 vs 2.48, p=0.14) were nominally seen with the combined systems. The incidence of symptomatic intracranial hemorrhage was significantly lower with the combined systems compared to our conventional set up (0% vs. 8.8%, p=0.01). In addition, the lowest listed price of the combined delivery systems including a microwire was nearly $1,000 greater than our traditional aspiration thrombectomy system ($5,671 vs. $4,674). Eliminating the use of a microwire, which is outside of the Instructions for Use for the SENDit and Cheetah, but acceptable with the Tenzing delivery catheter, results in a marginal cost difference between the combined ($4,900) and traditional systems ($4,674).

Conclusions
The introduction of the combined delivery catheter systems has the potential to enhance mechanical thrombectomies for acute ischemic stroke. Our cohort's early use data shows promise in reducing reperfusion times and enhancing technical success and safety, allowing for better patient outcomes at a marginally increased financial cost. Further prospective studies are warranted to establish these devices as improved options for stroke intervention.