Monopoint Reperfusion System shows consistent performance in tortuous vasculature during thrombectom

Introduction/Purpose Tri‐axial device systems have been commonly employed for acute cerebrovascular ischemic stroke thrombectomy. A newer generation of large‐bore aspiration catheters have been introduced to improve contact aspiration efficacy; however, the ledge‐effect due to lumen sizing differences between large‐bore aspiration catheters and intermediate catheters may impede endovascular navigation. The Monopoint Reperfusion System (Route 92 Medical, San Mateo, CA) is a novel, simple thrombectomy platform involving a large‐bore aspiration catheter (HiPoint 88) delivered over a delivery catheter (Tenzing 8) through a base catheter (BaseCamp). It is synergistically designed to reduce lumen size discrepancy causing the ledge effect. Outside of the recently‐completed clinical trial (SUMMIT MAX), there is limited real‐world experience on its performance in challenging tortuous vasculature. Materials and Methods Consecutive adult patients with acute anterior large vessel occlusion strokes in ICA and M1 segments treated with the Monopoint Reperfusion System on first pass over five years (January 2019‐December 2024) were retrospectively reviewed. Association between tortuous features (i.e., carotid kink, loop, coil, ICA hairpin turn, cavernous ICA tortuosity grade) and successful navigation to the clot, first pass effect (mTICI 2C/3 on first pass), and modified first pass effect (mTICI 2B/2C/3 on first pass) were characterized with multivariable logistic regressions. Results Of 165 patients, median age was 67 (IQR 60‐78). Carotid kinks were present in 37.6% (62/165). Loops or coils were present in 10.3% (17/165). An ICA 180‐degree turn/hairpin appearance was present in 16.4% (27/165). Less tortuous cavernous ICA grades (1A/1B/2) were present in 69.7% (115/165). In multivariable regressions, none of these features were significantly associated with successful delivery of aspiration catheter to the occlusion (all p>0.06), first pass effect (all p>0.11), and modified first pass effect (all p>0.17). Conclusion This multicenter study with the Monopoint Reperfusion System demonstrated that likelihood of achieving favorable intra‐procedural outcomes in thrombectomy was not significantly impacted by the presence of tortuous vasculature. These findings suggest favorable, consistent performance of this system in patients with tortuous vasculature.