This in-vitro study compared three aspiration thrombectomy approaches for LVO stroke — conventional aspiration (CA) using a 6Fr React 71 catheter, Superbore Aspiration Catheter (SAC: Millipede88, 0.088″ lumen), and Cyclic Aspiration (CycA: React 71 with proprietary cyclic pressure waveform) — across soft, mixed, and stiff ovine blood clots lodged in ICA and MCA-M1 segments, using First Pass Effect (FPE), Complete Clot Ingestion (CCI), Final Complete Revascularization (mTICI 2c/3 within 3 passes), and distal emboli rates as endpoints.
SAC outperformed both CA and CycA: MCA FPE 88% vs. 71% (CA) vs. 62% (CycA); ICA Final Complete Revascularization 91% vs. 79% for both CA and CycA; and SAC had the fewest distal emboli overall. CycA improved CCI over CA in ICA occlusions (26% vs. 9%) but generated the most distal emboli, particularly in ICA, and did not improve Final Complete Revascularization.
Results come entirely from an in-vitro model — safety outcomes (hemorrhage, perforation) cannot be assessed, and the model lacks M3/M4 vessels, limiting emboli assessment and final tissue revascularization scoring. Only one device per class was tested (Millipede88, React 71, one CycA system), so findings should not be generalized to all superbore or cyclic aspiration devices.
In this bench model, superbore aspiration (Millipede88) achieved the highest rates of first-pass revascularization and the lowest distal emboli for both ICA and MCA occlusions, supporting its use as a frontline aspiration strategy where anatomy allows. Cyclic aspiration improved clot ingestion in ICA occlusions but increased distal embolization, suggesting adjuncts like balloon guide catheters should be evaluated before broad clinical adoption.
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