Zoom Catheters Improve Thrombectomy Outcomes in Acute Ischemic Stroke

Introduction Zoom 0.088” access catheters (Imperative Care, USA) are superbore guide catheters designed to improve cervical stability and procedural efficiency during mechanical thrombectomy for acute ischemic stroke. While its use has grown in practice, comparative real‐world data against conventional and previous‐generation guide catheters remain limited. We aimed to evaluate angiographic and procedural outcomes in patients treated with these superbore catheters compared to the cohort prior to their adoption. Methods We retrospectively evaluated patients undergoing mechanical thrombectomy for anterior‐circulation non‐tandem large vessel occlusions (LVOs: ICA‐terminus, M1, or proximal M2) at our comprehensive stroke center between January 2019 and April 2024. Patients were divided into two cohorts: those treated prior to adoption of Zoom intracranial access catheters at our center and those treated with one of the Zoom superbore catheters (Zoom 88, Zoom 88 Support, Zoom RDL) as the primary guide catheter. Baseline variables collected included age, presenting NIHSS, last‐known‐well to puncture time, and occlusion site. Outcomes of interest included first‐pass effect (FPE, defined as mTICI 2c/3 after a single pass), puncture‐to‐recanalization time, total number of passes, intraprocedural vasospasm of any vessel requiring treatment, catheter‐related dissection or contrast extravasation, complete reperfusion (final mTICI 2c–3), and 90‐day mortality. Results 194 LVOs were identified from 193 unique patients (96 pre‐Zoom; 95 Zoom). Baseline demographics and stroke severity were similar between cohorts. Median age was 71 [56–81] years in the pre‐Zoom cohort and 71.5 [57.75–80.25] years in the Zoom cohort. Median NIHSS was 16 [10–19.75] (pre‐Zoom) versus 16 [12–21] (Zoom). Median device‐to‐last‐known‐well times were 307.5 [184.5–620.5] (pre‐Zoom) versus 319 [188.75–801] minutes (Zoom; p = 0.251). Distributions of LVOs across ICA terminus, M1, and M2 occlusions were similar between cohorts (Pre‐Zoom: ICA‐T 22.9%, M1 56.3%, M2 20.8% vs Zoom: ICA‐T 14.7%, M1 66.3%; M2 18.9%; χ 2 , p = 0.277). We found that median puncture‐to‐reperfusion times were significantly shorter in the Zoom cohort (26.5 [17–41.50] versus 20.5 [14–32] min., p = 0.044). The median number of passes was similar (2 [1–3] vs 2 [1–3], p = 0.100). FPE was achieved in 32.3% (pre‐Zoom) versus 37.9% of cases (Zoom; p = 0.451). Intraprocedural vasospasm was significantly less frequent with Zoom guide catheter use (16.7% vs 5.3%, p = 0.019). Catheter‐related dissection was rare in both groups (3.1% vs 2.1%, p = >0.999). Complete reperfusion (final mTICI 2c–3) was achieved in 67.7% (pre‐Zoom) versus 62.1% of cases (Zoom; p = 0.451). 90‐day mortality was 28.1% (pre‐Zoom) versus 24.2% (Zoom; p = 0.622). Conclusion In this single‐center retrospective study, we found that Zoom superbore guide catheter use was feasible and safe, and offered shorter puncture‐to‐reperfusion times with lower rates of intraprocedural vasospasm compared to prior guide catheters, with otherwise comparable reperfusion, complication, and mortality rates.