Dual-Aspiration Technique Enhances Thrombectomy Outcomes in Large Vessel Occlusion

Introduction/Purpose Randomized controlled trials have demonstrated the benefits of mechanical thrombectomy in patients with emergent large vessel occlusion (ELVO). 1‐2 Various procedural techniques have been described, including balloon guide catheter use, stentriever/aspiration catheter choice, partial/full‐retrieval techniques, wire/catheter advancement methods, aspiration modalities, and nuances in how an operator pulls a system. 3 Each technique possesses various risk and benefits depending on vasculature and clinical scenario, and no consensus on optimal approach exists. The Socrates 38 catheter (Scientia Vascular, West Valley City, UT, USA) is a microfabricated aspiration catheter that, when paired with the Colossus Guidewire, can be used with traditional catheters to create a dual‐aspiration system thereby enhancing clot engagement and maintaining structural integrity. 2 This study reports a single‐center experience using this dual‐aspiration technique for mechanical thrombectomy in patients with ELVO. Materials/Methods This review included 1395 mechanical thrombectomy cases (July 2020‐August 2025). Patients were excluded if they did not undergo thrombectomy using a dual‐aspiration technique; a Socrates 38 catheter is advanced to the face of the thrombus, or through it, and a secondary 6‐Fr aspiration catheter (Penumbra Red [Penumbra, Alameda, CA, USA], Sofia [Terumo, Aliso Viejo, CA, USA]) is advanced over the system. Both catheters are then attached to aspiration and sequentially removed. Details on demographics, procedural data, complications, and technical and clinical outcomes were assessed. Complications were categorized based on timing; intra‐procedural (vessel injury/dissection) or post‐procedural/delayed (subarachnoid hemorrhage [SAH], hemorrhagic transformation, cerebral edema, surgical hemicraniectomy). Outcomes included baseline/discharge National Institutes of Health Stroke Scale (NIHSS), modified Thrombolysis in Cerebral Infarction (mTICI) scores, and 90‐day modified Rankin Scale (mRS). Results Twenty‐eight patients met inclusion criteria. The mean age was 69.1 years (± 13.8) with 19 females (67.9%). The mean baseline NIHSS was 17.5 (± 10.0). The majority of occlusions involved the M1 (60.7%), while others involved the M2 (21.4%), intracranial ICA (10.7%), A2 (3.6%), or basilar artery (3.6%). First‐pass recanalization was achieved in 9 patients (32.1%), and recanalization was achieved with a mean number of 2.4 passes (± 1.5). Good mTICI outcome (≥2b) was achieved in 27 patients, of which 23 had an excellent outcome (≥2c). Seven cases necessitated the use of an adjunctive stentriever device. The mean discharge NIHSS was 9.6 (± 9.4), with a mean change in NIHSS of 5.8 (± 6.3) between baseline and discharge. There were no intra‐procedural vessel injuries or dissections. Post‐thrombectomy SAH occurred in 5 patients, none requiring endovascular intervention. Delayed complications, including SAH, occurred in 13 patients (46.4%) and were not considered device‐related. Five in‐hospital deaths were reported: one from failed recanalization, two following SAH, and two attributed to stroke progression. 90‐day mRS were available in 10 patients due to recent use of this technique. Among them, 5 patients reported living independently (mRS 0‐2), and 3 of those experienced excellent functional outcomes (0‐1). Conclusion In this study, a dual‐aspiration technique using a Socrates 38 in conjunction with another 6‐Fr aspiration catheter demonstrated high‐rates of recanalization and favorable functional outcomes. These findings support continued exploration of the catheter's capabilities and potential to improve outcomes in stroke patients.