Mechanical Embolectomy Research Articles

037. Outcomes of Management of Adult Patients with Acute Limb Ischemia Using Catheter-Directed Thrombolysis (CDT) and Thrombectomy: A Systematic Review

Background: Acute limb ischemia (ALI) is one of the arterial emergencies of sudden decrease in limb perfusion and poses a threat to limb viability. Immediate management is required for better prognosis of the patient. Treatment with Catheter-directed thrombolysis (CDT) and thrombectomy methods have their own advantages and disadvantages that require further study. Methods: The authors completed a descriptive systematic review of retrospective cohort studies and randomised controlled trials (RCTs) based on PRISMA guidelines, including studies that included CDT and thrombectomy interventions in patients with acute limb ischemia. Data were extracted on sample size, age, diagnosis, mechanism of intervention, treatment outcome and complications. Results: Of the 304 studies, the authors included 5 cohort studies and RCTs, with a total sample size of 5,781 samples aged 60-72 years. All studies used CDT method, compared with various thrombectomy (Percutaneous aspiration thrombectomy (PAT), Pharmacomechanical thrombectomy (PMT), Percutaneous mechanical thrombectomy (PMT), Catheter-based thrombectomy (CBT), and Operative embolectomy. It was found that therapeutic outcomes based on risk of amputation, mortality and complications did not show significant differences between the two groups, but hospitalisation duration outcomes appeared longer in patients with CDT than thrombectomy (p value 0.0001 and 0.000). Conclusion: ALI is a condition that requires immediate management to reopen arterial flow so that ischaemic conditions in the tissue can be avoided, various intervention methods either with medication (thrombolysis) or invasive procedures with thrombectomy are considered to provide good outcomes in patients.

Coronary embolisation of native aortic valve debris during transcatheter aortic valve replacement: mechanical embolectomy and histopathological analysis

Coronary embolisation of native aortic valve debris during transcatheter aortic valve replacement: mechanical embolectomy and histopathological analysis

A nomogram predicts early neurological deterioration after mechanical thrombectomy in patients with ischemic stroke.

Early neurological deterioration (END) is common in acute ischemic stroke and is directly associated with poor outcome after stroke. Our aim is to develop and validate a nomogram to predict the risk of END after mechanical thrombectomy (MT) in acute ischemic stroke patients with anterior circulation large-vessel occlusion. We conducted a real-world, multi-center study in patients with stroke treated with mechanical thrombectomy. END was defined as a worsening by 2 or more NIHSS points within 72-hour after stroke onset compared to admission. Multivariable logistic regression was used to determine the independent predictors of END, and the discrimination of the scale was assessed using the C-index. Calibration curves were constructed to evaluate the calibration of the nomogram, and decision curves were used to describe the benefits of using the nomogram. A total of 1007 patients were included in our study. Multivariate logistic regression analysis found age, admission systolic blood pressure, initial NIHSS scores, history of hyperlipemia, and location of occlusion were independent predictors of END. We developed a nomogram that included these 6 factors, and it revealed a prognostic accuracy with a C-index of 0.678 in the derivation group and 0.650 in the validation group. The calibration curves showed that the nomogram provided a good fit to the data, and the decision curves demonstrated a large net benefit. Our study established and validated a nomogram to stratify the risk of END before mechanical embolectomy and identify high-risk patients, who should be more cautious when making clinical decisions.

When should we involve interventional radiology in the management of acute pulmonary embolism?

Pulmonary embolism (PE) is a common disease associated with high morbidity and mortality. Currently, guidelines recommend systemic thrombolysis in patients with haemodynamic instability (high-risk PE) or patients with intermediate-high-risk PE with haemodynamic deterioration. Nevertheless, more than half of high-risk PE patients do not receive systemic thrombolysis due to a perceived increased risk of bleeding. In these cases, percutaneous catheter-directed therapy (CDT) or surgical embolectomy should be considered. CDT has emerged and appears to be an effective alternative in treating PE, with a hypothetical lower risk of bleeding than systemic thrombolysis, acting directly in the thrombus with a much lower dose of thrombolytic drug or even without thrombolytic therapy. CDT techniques include catheter-directed clot aspiration or fragmentation, mechanical embolectomy, local thrombolysis, and combined pharmaco-mechanical approaches. A few observational prospective studies have demonstrated that CDT improves right ventricular function with a low rate of haemorrhage. Nevertheless, the evidence from randomised controlled trials is scarce. Here we review different scenarios where CDT may be useful and trials ongoing in this field. These results may change the upcoming guidelines for management and treatment of PE, establishing CDT as a recommended treatment in patients with acute intermediate-high-risk PE.

C-41 | Chronic Thromboembolic Pulmonary Hypertension (CTEPH) Trends, Procedural and In-Hospital Outcomes: A Nationwide Cohort Analysis of US (2017-2020)

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, potentially life-threatening disease of the pulmonary vasculature, is a distinct entity (group 4) in the classification of pulmonary hypertension. The available data regarding procedures for CTEPH and hospital outcomes is limited. This analysis included data from the National Inpatient Sample between January 2017 and December 2020. We reported the baseline characteristics and hospital outcomes of hospitalized patients with CTEPH. We also studied the procedural and mortality trends among these patients. We identified 17909 CTEPH hospitalizations during 2017-2020. Median age of identified cases was 63 years, 57% were females and 59% were white. Overall, the inpatient mortality during the study period was 4.89% with nearly stable rates of mortality throughout the studied years. 39.1% of the identified cases developed respiratory failure and 4.75% of them had respiratory failure requiring mechanical ventilation. The most commonly used procedure among the study period was surgical thrombectomy (ST) 9.91% of the cases followed by balloon pulmonary angioplasty (BPA) in 1.79% and then mechanical embolectomy (ME) in 1.2%. We observed increasing trend in ST preference which was associated with 100% mortality with the procedure, however improved mortality in 2020 with ST 62.5%, was seen. The overall length of stay was 6 days while the mean inflation-adjusted cost was $31,490,36. SE has been the most commonly used procedure throughout the studied years and is associated with highest procedural mortality compared to BAP & MT.

Outcomes of Percutaneous Mechanical Embolectomy for High-Risk Pulmonary Embolism: Insights from the Full US Cohort of the FLASH Registry

Outcomes of Percutaneous Mechanical Embolectomy for High-Risk Pulmonary Embolism: Insights from the Full US Cohort of the FLASH Registry

Percutaneous Management of High-Risk Pulmonary Embolism.

Acute pulmonary embolism (PE) leads to an abrupt increase in pulmonary vascular resistance and right ventricular afterload, and when significant enough, can result in hemodynamic instability. High-risk PE is a dire cardiovascular emergency and portends a poor prognosis. Traditional therapeutic options to rapidly reduce thrombus burden like systemic thrombolysis and surgical pulmonary endarterectomy have limitations, both with regards to appropriate candidates and efficacy, and have limited data demonstrating their benefit in high-risk PE. There are growing percutaneous treatment options for acute PE that include both localized thrombolysis and mechanical embolectomy. Data for such therapies with high-risk PE are currently limited. However, given the limitations, there is an opportunity to improve outcomes, with percutaneous treatments options offering new mechanisms for clot reduction with a possible improved safety profile compared with systemic thrombolysis. Additionally, mechanical circulatory support options allow for complementary treatment for patients with persistent instability, allowing for a bridge to more definitive treatment options. As more data develop, a shift toward a percutaneous approach with mechanical circulatory support may become a preferred option for the management of high-risk PE at tertiary care centers.

Global and national trends in the evolution of infective endocarditis

For the recent 20 years, substantial changes have occurred in all aspects of infectious endocarditis (IE), the evolution of risk factors, modernization of diagnostic methods, therapeutic and preventive approaches. The global trends are characterized by increased IE morbidity among people older than 65 who use intravenous psychoactive drugs. The epidemiological trend is represented by reduced roles of chronic rheumatic heart disease and congenital heart defects, increased proportion of IE associated with medical care, valve replacement, installation of intracardiac devices, and increased contribution of Staphylococcus spp. and Enterococcus spp. to the IE etiology. Additional visualization methods (fluorodeoxyglucose positron emission tomography with 18F-fludesoxyglucose (18F-FDG PET-CT), labeled white blood cell single-photon emission computed tomography (SPECT), and modernization of the etiological diagnostic algorithm for determining the true pathogen (immunochemistry, polymerase chain reaction, sequencing) also become increasingly important. The COVID-19 pandemic has also adversely contributed to the IE epidemiology. New prospects of treatment have emerged, such as bacteriophages, lysins, oral antibacterial therapy, minimally invasive surgical strategies (percutaneous mechanical aspiration), endovascular mechanical embolectomy. The physicians' compliance with clinical guidelines (CG) is low, which contributes to the high rate of adverse outcomes of IE, while simple adherence to the CG together with more frequent use of surgical treatment doubles survival. Systematic adherence to CG, timely prevention and implementation of the Endocarditis Team into practice play the decisive role in a favorable prognosis of dynamically changing IE. This article presents the authors' own data that confirm the evolutionary trends of current IE.

Successful percutaneous catheter-directed treatment of high-risk pulmonary embolism: a case report

Pulmonary embolism (PE) is an acute cardiovascular syndrome characterized by high incidence and mortality. The therapy of this condition is based on anticoagulation and hemodynamic support, but in case of high-risk mortality, the European Society of Cardiology (ESC) guidelines recommend systemic thrombolytic therapy and surgical embolectomy if thrombolysis is contraindicated or has failed; nowadays several percutaneous catheter-directed treatments for local thrombolysis or mechanical embolectomy are available, but they have IIa class of recommendation, because of lack of robust scientific evidence favoring their use. We described a case of high-risk PE treated with a novel percutaneous system for mechanical embolectomy, which consists of a large aspiration catheter that was advanced in the pulmonary artery, capturing and removing a vast thrombus, of 15 centimeters in length. This therapeutic strategy avoided the risk of hemorrhagic complications related to systemic thrombolysis, exiting in the achievement of fast patient hemodynamic stabilization and symptoms resolution, without complications. Computed tomography (CT) pulmonary angiography after 10 days from the intervention revealed the complete resolution of pulmonary artery filling defects, and the patient was discharged asymptomatic. Percutaneous catheter-directed treatments represent an effective alternative therapy for PE, but further studies are needed to demonstrate safety and superiority over the actually recommended therapy.

A Simple Grading Scale for Predicting Symptomatic Intracranial Hemorrhage after Mechanical Thrombectomy

Introduction: Hemorrhagic transformation, especially symptomatic intracranial hemorrhage (sICH), is a common complication after mechanical embolectomy. This study explored a grading scale based on clinical and radiological parameters to predict sICH after mechanical embolectomy. Methods: Demographic and clinical data were retrospectively collected from patients with acute ischemic stroke treated with mechanical embolectomy at West China Hospital. Clinical and radiological factors associated with sICH were identified and used to develop the “STBA” grading scale. This score was then validated using data from an independent sample at the First Affiliated Hospital of Kunming Medical University. Results: We analyzed 268 patients with acute ischemic stroke who were treated with mechanical embolectomy at West China Hospital, of whom 30 (11.2%) had sICH. Patients were rated on an “STBA” score ranging from 0 to 6 based on whether systolic blood pressure was ≥145 mm Hg at admission (yes = 2 points; no = 0 points), time from acute ischemic stroke until groin puncture was ≥300 min (yes = 1; no = 0), blood glucose was ≥8.8 mmol/L (yes = 1; no = 0), and the Alberta Stroke Program Early Computed Tomography score at admission was 0–5 (2 points), 6–7 (1 point), or 8–10 (0 points). The STBA score showed good discrimination in the derivation sample (area under the receiver operating characteristic curve = 0.858) and in the validation sample (area = 0.814). Conclusions: The STBA score may be a reliable clinical scoring system to predict sICH in acute ischemic stroke patients treated with mechanical embolectomy.

A RARE CASE OF THROMBUS IN TRANSIT MIGRATION TO THE MAIN PULMONARY ARTERY IN A PATIENT WITH SUBMASSIVE PULMONARY EMBOLISM

A RARE CASE OF THROMBUS IN TRANSIT MIGRATION TO THE MAIN PULMONARY ARTERY IN A PATIENT WITH SUBMASSIVE PULMONARY EMBOLISM

OPTIMAL REPERFUSION STRATEGY IN ACUTE HIGH-RISK PULMONARY EMBOLISM REQUIRING EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT: A SYSTEMATIC REVIEW AND META-ANALYSIS

TYPE: Late Breaking Abstract TOPIC: Pulmonary Vascular Disease PURPOSE: Optimal pulmonary revascularization strategy in acute high-risk pulmonary embolism (PE) requiring implantation of extracorporeal membrane oxygenation (ECMO) remains controversial. METHODS: We conducted a systematic review and meta-analysis of available evidence comparing mechanical embolectomy and other strategies, including systemic or catheter-directed thrombolysis, or ECMO as stand-alone therapy, with regard to mortality and bleeding outcomes. RESULTS: We identified 835 studies;17 were included, comprising 353 PE ECMO-treated patients. Overall, 30.8% had mechanical pulmonary reperfusion, (of whom 89.9% surgical embolectomy), while 69.1% received other strategies. Mortality rate was 23.0% in the mechanical reperfusion group and 43.1% in the other strategy group. The pooled OR for mortality with mechanical reperfusion was 0.46 (95%CI, 0.213-0.997; I2 = 28.3%) versus other reperfusion strategies; and 0.37 (95% CI, 0.18-0.78; p = 0.009; I 2 = 14.8%) for any surgical embolectomy vs thrombolysis. The bleeding rate in ECMO patients was 29.1% in the mechanical reperfusion group and 26.0% in the other reperfusion group (OR, 1.09; 95% CI, 0.46-2.54; I2, 0.0%) among 10 eligible studies with available bleeding data. Meta-regression did not identify any relationship between the covariates “more than one pulmonary reperfusion therapy” and “ECMO implantation before pulmonary reperfusion therapy”, and associated outcomes. CONCLUSIONS: The results of this meta-analysis and meta-regression suggest that mechanical reperfusion, notably surgical embolectomy, yields favorable results regardless of the timing of ECMO implantation in the reperfusion timeline, and independent of thrombolysis administration. CLINICAL IMPLICATIONS: Mechanical pulmonary reperfusion, especially surgical embolectomy, seems to be more effective than other strategies, especially thrombolysis, for mitigating mortality risk, at similar bleeding risk. DISCLOSURE: Grants from BMS/Pfizer, BSC, Amgen, Bayer, Janssen, Portola (GP); Honoraria from Getinge, Drager, Fresenius (MS); Honoraria from Abbott, BMS-Pfizer, Bayer, Edwards Lifesciences, Terumo (NM); Travel support from Daiichi Sankyo, Pfizer (ISC) KEYWORD: pulmonary embolism

Extended Use of Distal Embolic Protection Devices in Treatment of Distal Embolism During Lower Extremity Arterial Endovascular Interventions.

There is no consensus on the best treatment modality for acute distal embolization complications during endovascular interventions for peripheral arterial diseases. We report on 3 patients who underwent mechanical embolectomy using a distal embolic protection device (EPD). All patients showed angiographic evidence of distal embolism, which occurred during lower extremity limb salvage endovascular procedures. After embolectomy, all had complete recanalization of the involved vessel on completion angiogram, and none had any device-related complications or adverse outcomes from the embolization. This initial experience suggests that EPD can be used for both the prevention and treatment of intraoperative distal embolization during endovascular intervention of lower extremity arterial disease.

Optimal reperfusion strategy in acute high-risk pulmonary embolism requiring extracorporeal membrane oxygenation support: a systematic review and meta-analysis.

The optimal pulmonary revascularisation strategy in high-risk pulmonary embolism (PE) requiring implantation of extracorporeal membrane oxygenation (ECMO) remains controversial. We conducted a systematic review and meta-analysis of evidence comparing mechanical embolectomy and other strategies, including systemic thrombolysis, catheter-directed thrombolysis or ECMO as stand-alone therapy, with regard to mortality and bleeding outcomes. We identified 835 studies, 17 of which were included, comprising 327 PE patients. Overall, 32.4% were treated with mechanical pulmonary reperfusion (of whom 85.9% had surgical embolectomy), while 67.6% received other strategies. The mortality rate was 22.6% in the mechanical reperfusion group and 42.8% in the "other strategies" group. The pooled odds ratio for mortality with mechanical reperfusion was 0.439 (95% CI 0.237-0.816) (p=0.009; I2=35.2%) versus other reperfusion strategies and 0.368 (95% CI 0.185-0.733) (p=0.004; I2=32.9%) for surgical embolectomy versus thrombolysis. The rate of bleeding in patients under ECMO was 22.2% in the mechanical reperfusion group and 19.1% in the "other strategies" group (OR 1.27, 95% CI 0.54-2.96; I2=7.7%). The meta-regression model did not identify any relationship between the covariates "more than one pulmonary reperfusion therapy", "ECMO implantation before pulmonary reperfusion therapy", "clinical presentation of PE" or "cancer-associated PE" and the associated outcomes. The results of the present meta-analysis and meta-regression suggest that mechanical reperfusion, notably by surgical embolectomy, may yield favourable results regardless of the timing of ECMO implantation in the reperfusion timeline, independent of thrombolysis administration or cardiac arrest presentation.

Thrombectomy of Inferior Vena Cava Fat Embolism after Trauma

A 19-year-old man involved in a head-on motor vehicle collision presented with multiple injuries, including a displaced right femur fracture. Two days after presentation, a computed tomography scan was obtained to evaluate new-onset hematuria, and it showed an extensive hypoattenuating filling defect in the inferior vena cava (IVC) (Fig 1), concerning for free-floating fat embolus. The interventional radiology department was consulted for embolectomy due to the risk of pulmonary embolism, contraindication for anticoagulation in the setting of trauma, and decreased likelihood of fat thrombus responding to anticoagulation. Cavogram showed an extensive right iliocaval filling defect (Fig 2a). A suprarenal IVC filter was placed prior to embolectomy to prevent central migration. Following mechanical embolectomy using an Amplatz Goose Neck Snare (Medtronic, Minneapolis, Minnesota) and suction via guiding catheters, a repeat cavogram demonstrated partially embolized fat thrombus trapped at the IVC filter apex (Fig 2b), which was removed with the snare. Histopathology of the fat emboli (Fig 2c) showed “thrombus with entrapped fat.”

MULTIORGAN FAILURE AND SEVERE THROMBOCYTOPENIA FROM MASSIVE PULMONARY EMBOLISM WITH A CHALLENGING MANAGEMENT

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Thrombocytopenia can make management of pulmonary embolism (PE) challenging due to increased risk of bleeding. We present a case of massive PE with obstructive shock, and severe thrombocytopenia. CASE PRESENTATION: 62-year-old man with no medical history presented with 6-day history of shortness of breath, lethargy, and syncope. Initial vitals showed temperature 100.1, blood pressure 73/62 mmHg, heart rate 91, respiratory rate 34 bpm and oxygen saturation 93% on 3 L oxygen. Examination showed jugular venous distension and right calf swelling. Labs showed severe thrombocytopenia of 31,000/L, elevated D-dimer of 25,384 ng/m, creatinine of 2.6 mg/dL, lactic acid of 9.8 mmol/L, ALT of 6675 IU/L, AST of 6499 IU/L, and troponin of 0.33 ng/mL. Venous doppler ultrasound showed acute thrombosis of right popliteal vein. Patient was started on heparin drip. CTA chest showed extensive bilateral pulmonary emboli, saddle embolus, dilatation of the right heart and 2.7 cm right atrium thrombus. The severe thrombocytopenia precluded thrombolytics. After emergent multidisciplinary round, patient was given steroids, transfused platelets and underwent veno-arterial extra-corporeal membrane oxygenation (VA ECMO). Patient was transferred to center capable of thrombectomy where he underwent embolectomy and subsequently discharged. DISCUSSION: PE remains a leading cause of mortality and morbidity. The management depends on the severity. Massive is defined as acute PE with sustained hypotension, pulselessness, or persistent profound bradycardia. Management of massive PE includes cardiopulmonary support, anticoagulation to prevent extension and recurrence, and reperfusion of the pulmonary artery. Reperfusion therapy includes systemic thrombolysis or mechanical intervention with either catheter directed thrombolysis or thrombectomy. Mechanical embolectomy is indicated in patients with contraindications to thrombolytic therapy, however, mechanical embolectomy is not readily available in many centers. Cardiopulmonary support should first be initiated with supplemental oxygen, intravenous fluid, and inotropic agents. If the right ventricle fails to respond appropriately to inotropes, the initiation of more aggressive adjunctive measures such as surgery or extra-corporeal membrane oxygenation (ECMO) can be considered in preparation for embolectomy. Early institution of ECMO is important before initiation of advanced airway because these patients are preload dependent and mechanical ventilation can decrease their venous return and hence cardiovascular collapse. Our patient was not a candidate for thrombolytic therapy due to severe thrombocytopenia, VA ECMO was performed but transfer. CONCLUSIONS: This case demonstrates the important of multidisciplinary decision making, the role of ECMO in massive PE with severe right ventricular dysfunction; and surgical embolectomy in patients with contraindication to thrombolytics. REFERENCE #1: Português J, Calvo L, Oliveira M, et al. Pulmonary Embolism and Intracardiac Type A Thrombus with an Unexpected Outcome. Case Reports in Cardiology. 2017;2017:1-5. doi:10.1155/2017/9092576 REFERENCE #2: Erythropoulou-Kaltsidou A, Alkagiet S, Tziomalos K. New guidelines for the diagnosis and management of pulmonary embolism: Key changes. World J Cardiol. 2020;12(5):161-166. doi:10.4330/wjc.v12.i5.161 REFERENCE #3: Martinez Licha CR, McCurdy CM, Maldonado SM, Lee LS. Current Management of Acute Pulmonary Embolism. Ann Thorac Cardiovasc Surg. 2020;26(2):65-71. doi:10.5761/atcs.ra.19-00158 DISCLOSURES: No relevant relationships by Oluwafemi Ajibola, source=Web Response No relevant relationships by Mohammad Khan, source=Web Response No relevant relationships by David Kung, source=Web Response No relevant relationships by Joseph Kuruvilla, source=Web Response No relevant relationships by Pang Lam, source=Web Response No relevant relationships by Hussan Rahim, source=Web Response No relevant relationships by Srivyshnavi Ramineni, source=Web Response

Surgical Management of Acute Mesenteric Ischemia; Review Article

Mesenteric ischemia is a condition in which the amount of oxygen available is insufficient to meet the needs of the intestines. The small intestine, colon, or both can be affected by ischemia. The most common cause of occlusive ischemia is an abrupt obstruction of a major artery, which causes a considerable drop in intestinal blood flow. Early diagnosis is one of the most essential components in achieving a favorable outcome. The most prevalent treatment is surgical management. However, there are minimally invasive therapy alternatives that have been shown in observational studies. For arterial thrombosis, endovascular stenting is an option, and anticoagulation is an option for venous thrombosis. Endovascular aspiration, mechanical embolectomy, and local thrombolysis are all possibilities for patients with arterial embolism.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery: A Scientific Statement From the American Heart Association/American Stroke Association.

Perioperative stroke is a potentially devastating complication in patients undergoing noncardiac, nonneurological surgery. This scientific statement summarizes established risk factors for perioperative stroke, preoperative and intraoperative strategies to mitigate the risk of stroke, suggestions for postoperative assessments, and treatment approaches for minimizing permanent neurological dysfunction in patients who experience a perioperative stroke. The first section focuses on preoperative optimization, including the role of preoperative carotid revascularization in patients with high-grade carotid stenosis and delaying surgery in patients with recent strokes. The second section reviews intraoperative strategies to reduce the risk of stroke, focusing on blood pressure control, perioperative goal-directed therapy, blood transfusion, and anesthetic technique. Finally, this statement presents strategies for the evaluation and treatment of patients with suspected postoperative strokes and, in particular, highlights the value of rapid recognition of strokes and the early use of intravenous thrombolysis and mechanical embolectomy in appropriate patients.

Abstract P486: Mechanical Embolectomy Using a Novel Telescopic System Featuring a Specialized Delivery and 0.088” Aspiration Catheter for the Treatment of Acute Ischemic Stroke: Preliminary Results of the SUMMIT NZ Trial

Background: The treatment approach of aspiration rather than use of a stent retriever as first-line therapy is increasingly regarded as standard of care for acute ischemic stroke. Continued technological advances include the ongoing development of aspiration embolectomy catheters that are larger in bore, guided by delivery catheters that are more maneuverable through the tortuous neurovasculature. Methods: SUMMIT NZ (ACTRN12619000890134p) was designed as a prospective, single-arm, open label clinical trial at two sites in New Zealand. Eligible participants were patients presenting with acute ischemic stroke from either anterior or posterior circulation large-vessel occlusion within 24 hours of onset, a National Institutes of Health Stroke Scale Score ≥ 6 and a pre-stroke modified Rankin Score of ≤ 2. A novel tapered tip delivery catheter was specifically designed to deliver 0.070” and 0.088” aspiration catheters telescoped through a specialized 8F 90 cm introducer sheath (Route 92 Medical, Inc. San Mateo, CA). The primary effectiveness endpoint was arterial revascularization as measured by a modified Thrombosis in Cerebrovascular Infarction (mTICI) score of 2b or greater at the end of angiography after all endovascular treatments as adjudicated by an independent core laboratory. The primary safety endpoints were device-related peri-procedural complications such as dissection or perforation, symptomatic Intracranial Cerebral Hemorrhage (SICH) at 24 hours and embolization to a previously uninvolved territory. Results: From September 27, 2019 to June 23, 2020, 18 subjects (mean age 69.5, NIHSSS 15.2, time last known well 6.2 hours) were enrolled with a diagnosis of acute ischemic stroke. Acute occlusion was located in the middle cerebral artery (78%, 14/18) and internal carotid artery (22%, 4/18). Successful revascularization was achieved in 94% (17/18) of subjects. No serious adverse device effects have been reported. Conclusions: Preliminary findings suggest that aspiration first mechanical embolectomy using a novel telescoping system including an 0.088” inner diameter aspiration catheter achieves a high rate of arterial revascularization with an acceptable safety profile. A full report on enrollment and results are to be presented.