Large bore versus super large bore aspiration catheters in mechanical thrombectomy: a systematic review and meta-analysis

Background Endovascular thrombectomy (EVT) is a cornerstone treatment for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Super large bore (SLB) catheters represent the latest evolution in device design for aspiration technology; however, their benefit over standard large bore (LB) catheters remains uncertain. Methods A systematic literature search and proportional meta-analysis were conducted on studies reporting EVT outcomes with LB and SLB aspiration catheters. Both single-arm and comparative studies were included. The primary outcome was first-pass modified treatment in cerebral infarction (mTICI) score ≥2C (FPE2C). Secondary outcomes included safety and procedural measures. Random-effects models generated pooled estimates, with subgroup comparisons between LB and SLB and sensitivity analyses using leave-one-out and outlier exclusion. Results A total of 3966 patients (39 studies) were included in the primary analyses (SLB n=376; LB n=3590). FPE2C rates were similar between SLB and LB catheters (56% vs 50%; P=0.4). Final successful recanalization rates were high and similar in both groups (92% vs 92%; P=0.9). Procedural time did not differ, with pooled mean times of 27.03 min for SLB and 26.97 min for LB catheters. The need for rescue therapy showed a trend toward lower use with SLB compared with LB catheters (11% vs 20%; P=0.06). Rates of failure to reach the target clot showed a trend toward higher rates in the SLB group (10% vs 5%; P=0.11). Safety outcomes did not differ significantly (P>0.2). Conclusion SLB catheters did not demonstrate a clear advantage over LB catheters in reperfusion outcomes. Limited clinical data prevent conclusions on functional benefit, and further prospective studies are needed.