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Updated: Jun 21, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Faster reperfusion with combined delivery catheter systems in aspiration-first stroke thrombectomy: a multicenter
Keiko A Fukuda1,2, Mallory Blackwood2, Jungyoon Kim1
1Radiological Sciences, Division of Interventional Neuroradiology, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA.
Insights
Combined delivery catheter systems (CDCS) significantly improve mechanical thrombectomy efficiency, reducing reperfusion times and enhancing angiographic success. This aspiration-first strategy offers faster stroke treatment without compromising patient safety.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Medical Devices
Background:
- Mechanical thrombectomy is a key treatment for acute ischemic stroke.
- Combined Delivery Catheter Systems (CDCS) aim to improve aspiration-first thrombectomy efficiency.
- Limited multicenter data exist comparing CDCS platforms to traditional systems.
Purpose of the Study:
- To evaluate if an aspiration-first CDCS strategy enhances procedural efficiency.
- To assess if CDCS impacts angiographic success and patient safety compared to conventional methods.
- To analyze key procedural and clinical outcomes in a multicenter setting.
Main Methods:
- A retrospective multicenter cohort study analyzed aspiration-first thrombectomies from June 2023 to January 2025.
- CDCS platforms were compared against conventional microcatheter-guided aspiration.
- Primary outcome: groin-to-final-reperfusion time; Secondary outcomes: reperfusion rates (eTICI≥2b), passes, fluoroscopy time, safety, and functional outcomes (mRS).
Main Results:
- CDCS significantly reduced groin-to-final-reperfusion time (26.0 vs 41.0 min, p=0.001).
- CDCS demonstrated fewer passes, higher first-pass and final reperfusion rates (eTICI≥2b), and shorter fluoroscopy times.
- No significant difference in symptomatic intracranial hemorrhage or 90-day functional outcomes was observed between groups.
Conclusions:
- Aspiration-first CDCS strategy accelerates reperfusion and improves angiographic success in mechanical thrombectomy.
- The CDCS approach appears safe, with no increased risk of hemorrhage or worse functional outcomes.
- Further prospective studies and cost-effectiveness analyses are recommended to validate these findings.
Background:
Combined delivery catheter systems (CDCS) with ledge-reducing obturators are designed to streamline aspiration-first mechanical thrombectomy, yet comparative multicenter data across platforms remain limited.
Objective:
To determine whether an aspiration-first CDCS strategy improves procedural efficiency without compromising angiographic success or safety compared with traditional aspiration systems.
Methods:
A multicenter, retrospective cohort study was conducted using prospectively maintained registries of consecutive aspiration-first thrombectomies at three comprehensive stroke centers in the United States (June 2023-January 2025). CDCS (Route 92 FreeClimb 70-Tenzing, Penumbra RED 72-SENDit, Balt Carrier, Q'Apel Hippo-Cheetah) were compared with conventional microcatheter-guided aspiration. Primary outcome was groin-to-final-reperfusion time. Secondary outcomes included first-pass and final extended Thrombolysis in Cerebral Infarction (eTICI)≥2b reperfusion, number of passes, fluoroscopy time, symptomatic intracranial hemorrhage, and 90-day modified Rankin Scale scores. Multivariable models were adjusted for prespecified covariates.
Results:
The primary outcome, groin-to-final-reperfusion time (26.0 vs 41.0 min, p=0.001), was significantly shorter with CDCS (n=66). Secondary outcomes demonstrated fewer number of passes (1.8±1.3 vs 2.3±1.4, p=0.02), higher first-pass eTICI≥2b (66.7% vs 44.9%, p=0.009) and final eTICI≥2b (92.4% vs 78.2%, p=0.02) reperfusion rates, and lower fluoroscopy times (18.8 vs 24.5 min, p=0.02). Symptomatic intracranial hemorrhage occurred in 4.6% of CDCS versus 12.8% of traditional cases (p=0.14). There was no significant difference in 90-day functional outcomes between groups (3.6±1.9 vs 3.5±2.6, p=0.82). Findings remained significant after adjustment where applicable.
Conclusions:
An aspiration-first CDCS strategy was associated with faster reperfusion and higher angiographic success without apparent safety trade-offs. Prospective comparative and cost-effectiveness studies are warranted.
