P-009 An angled tip is associated with improved technical outcomes when using 0.064–0.074 aspiration catheters: analysis from a multicenter retrospective cohort (2021)

<h3>Background</h3> Recent introduction of large bore aspiration catheters have contributed to high reperfusion rates. The alteration of these catheters to have angled tips, which increase clot engagement area by approximately 15%, has been suggested to improve rates of complete clot ingestion, resulting in higher quality thrombectomies. We aimed to evaluate the recanalization efficacy of new generation angled tip aspiration catheters in comparison to commonly used straight tip aspiration catheters in real world data set. <h3>Methods</h3> We performed a multicenter retrospective analysis of consecutive acute ischemic stroke patients with M1 occlusion treated within 24 hours from the time of last known well. Patients were divided into two cohorts: those in whom a 0.071 angled tip catheter was the initial device used to attempt reperfusion and those in whom a 0.064-0.074 inch flat tip (non-angled) catheter was the initial device used to attempt reperfusion. The primary outcome was the rate of excellent reperfusion (TICI 2C). Secondary outcomes included the rate of successful reperfusion (TICI2B), use of stent retrievers, and access to successful reperfusion time. All data was self-adjudicated. No outside funding was provided for this analysis. <h3>Results</h3> Total of 650 patients with acute M1 occlusion who underwent thrombectomy were identified. Angled tip Zoom 71 catheter was used in 162 patients, while 488 patients were treated with flat tip aspiration catheters (ranging 0.064 to 0.074 inch in inner diameter). The baseline mRS score, admission NIHSS score, the rate of intravenous thrombolytic therapy, symptom onset to hospital arrival, and use of anesthesia were not different between the cohorts. The primary outcome was significantly higher in the angled tip cohort (67% vs 59%, p=0.03). There was no difference in the rate of TICI2B reperfusion (96% vs 94%, p=0.71). There was a lower rate of stent retriever use (25% vs 44%, p&lt;.0001) in the angled tip cohort. Access time to successful reperfusion was significantly faster with angled tip catheters (21 vs 29 minutes, p&lt;.0001). Access time to TICI 2B (25 vs 31 minutes, p=0.03) and final recanalization (29 vs 35 minutes, p=0.03) remained significantly shorter in the angled tip cohort, after adjusting for age, thrombectomy technique, use of secondary aspiration catheter. <h3>Conclusion</h3> This multicenter, consecutive real-world experience demonstrates that M1 thrombectomy with an angled tip aspiration catheter is associated with higher rates of TICI 2C or better reperfusion, equal rates of TICI 2B or better reperfusion, and faster time to successful reperfusion. <h3>Disclosures</h3> <b>J. Vargas:</b> None. <b>S. Majidi:</b> None. <b>H. Hawk:</b> None. <b>S. Nimjee:</b> None. <b>A. Zakeri:</b> None. <b>M. Mokin:</b> None. <b>R. Kellogg:</b> None. <b>G. Cortez:</b> None. <b>A. Aghaebrahim:</b> None. <b>E. Sauvageau:</b> None. <b>R. Hanel:</b> None. <b>R. De Leacy:</b> None. <b>A. Siddiqui:</b> None. <b>A. Turk:</b> None. <b>M. Oselkin:</b> None. <b>E. Marlin:</b> None. <b>R. Turner:</b> None. <b>I. Chaudry:</b> None. <b>J. Milburn:</b> None.