Abstract Background and aims Cyclical aspiration (CyA) may enhance first-pass recanalization (FPR) and clot ingestion without generating distal occlusions in acute ischemic stroke patients due to medium vessel occlusion. We evaluated the efficacy and safety of CyA versus static aspiration (StA) in distal segments using a 3D neurovascular flow model. Methods The M2 segment (proximal diameter: 2.65 mm; distal diameter: 1.5 mm) of the middle cerebral artery (MCA) was embolized with forty friable synthetic clots (length: 9.86 ± 0.32 mm). CyA and StA were modulated by a dual-solenoid aspiration system and tested with a 0.043″ catheter employing a direct aspiration technique. Experiments were randomized into two treatment arms: CyA-43 and StA-43. Endpoints included partial and complete FPR, clot ingestion, and distal embolization. Results Overall, partial FPR was achieved in 62.5% of cases (25/40), with CyA-43 outperforming StA-43 (80% vs 45%, p=0.05). Complete FPR was observed in 50% of cases (20/40), with CyA-43 showing higher rates than StA-43 (60% vs 40%, p=0.34). Clot ingestion rates differed significantly between aspiration techniques, favoring CyA-43 over StA-43 (95% vs 75%, p=0.03). A significant association was observed between clot ingestion and successful recanalization (59% vs 0% success, p=0.02), which was further enhanced when clot ingestion was complete (100% success for complete ingestion vs 50% for partial ingestion). No significant differences were observed in distal embolization between treatment arms. Conclusions CyA is effective for the treatment of distal segments (MCA-M2), ensuring successful recanalization due to improved clot ingestion, which may help prevent distal emboli. Conflict of interest Ariel Paredes: nothing to disclose Figure 1 - belongs to Results Figure 2 - belongs to Results
Paredes et al. (Fri,) studied this question.