Abstract
The incorporation of thrombo‐aspiration during mechanical thrombectomy for the treatment of acute ischemic stroke has emerged as an effective option to achieve favourable procedural outcomes. Thrombo‐aspiration can be conducted via continuous standard aspiration or by cyclic aspiration patterns. Recent studies have reported the benefits of retrieving clots with cyclic aspiration techniques in pre‐clinical models. We aim to compare a range of efficacy and safety outcomes of standard vs cyclic aspiration in a pre‐clinical setting. A systematic literature review of cyclic vs standard aspiration published by August 2025 was conducted using PubMed and Cochrane databases on the Nested Knowledge platform. Only pre‐clinical studies with both arms of static and cyclic were included. Data were extracted on procedural efficacy and safety outcomes. The primary outcome was a comparison of first pass recanalization (FPR) rates defined as complete clot removal in one pass in cyclic vs standard aspiration. Other outcomes included comparisons of flow rates, rate of clot ingestion, rate of complete clot ingestion, emboli count and vacuum pressures. Comparisons were performed using Welch's t‐tests and reported with 95% confidence intervals, where possible. Out of 430 articles screened, 9 studies were included that compared standard aspiration (n=258 experimental passes) to cyclic aspiration (n=284) using pumps (n=8 studies) or manual syringe techniques (n=1). There were a wide range of cyclic technologies and pre‐clinical model set‐ups including the vascular model and clots used. FPR rate trended higher with cyclic compared to standard aspiration techniques (84.7% CI [71.1, 98.3] vs 45.0% CI [3.2, 86.8], p=0.33). Catheter flow rates were lower upon aspiration using cyclic compared to the static (162.2 ml/min CI [122.6, 201.9], n=35 vs 311.0 ml/min CI [302.2, 319.8], n=5 experiments). In addition, cyclic aspiration was associated with a significantly greater average clot ingestion rate compared to standard aspiration techniques (63.0% CI [40.0, 85.9], n=233 vs 29.0% CI [15.3, 42.8], n=203, p=0.005). Complete clot ingestion rates trended higher in the cyclic compared to the standard aspiration group (31.4% CI [5.5, 57.3], n=157 vs 15.4% CI [‐1.3, 32.2], n=10, p=0.3). Additionally, the mean emboli count was lower in the cyclic (9.9 CI [‐4.6, 24.4], n=222) compared to the standard aspiration group (20.5 CI [1.2, 39.9], n=256). Intraprocedural pump vacuum pressures were comparable across the cyclic and standard (22.4 Hg CI [10.8, 34.0], n=36 vs 24.6 Hg CI [21.0, 28.1], n=70, p=0.78) aspiration groups. In conclusion, these data indicate more favourable efficacy and safety outcomes when cyclic aspiration patterns were incorporated into the mechanical thrombectomy procedure compared to standard aspiration techniques in a pre‐clinical setting.
Disclosure
Johnson and Johnson MedTech Neurovascular
