Faster reperfusion with combined delivery catheter systems in aspiration-first stroke thrombectomy: a multicenter analysis

Background: Combined delivery catheter systems (CDCS) with ledge-reducing obturators are designed to streamline aspiration-first mechanical thrombectomy, yet comparative multicenter data across platforms remain limited. Objective: To determine whether an aspiration-first CDCS strategy improves procedural efficiency without compromising angiographic success or safety compared with traditional aspiration systems. Methods: A multicenter, retrospective cohort study was conducted using prospectively maintained registries of consecutive aspiration-first thrombectomies at three comprehensive stroke centers in the United States (June 2023–January 2025). CDCS (Route 92 FreeClimb 70-Tenzing, Penumbra RED 72-SENDit, Balt Carrier, Q’Apel Hippo-Cheetah) were compared with conventional microcatheter-guided aspiration. Primary outcome was groin-to-final-reperfusion time. Secondary outcomes included first-pass and final extended Thrombolysis in Cerebral Infarction (eTICI)≥2b reperfusion, number of passes, fluoroscopy time, symptomatic intracranial hemorrhage, and 90-day modified Rankin Scale scores. Multivariable models were adjusted for prespecified covariates. Results: The primary outcome, groin-to-final-reperfusion time (26.0 vs 41.0 min, p=0.001), was significantly shorter with CDCS (n=66). Secondary outcomes demonstrated fewer number of passes (1.8±1.3 vs 2.3±1.4, p=0.02), higher first-pass eTICI≥2b (66.7% vs 44.9%, p=0.009) and final eTICI≥2b (92.4% vs 78.2%, p=0.02) reperfusion rates, and lower fluoroscopy times (18.8 vs 24.5 min, p=0.02). Symptomatic intracranial hemorrhage occurred in 4.6% of CDCS versus 12.8% of traditional cases (p=0.14). There was no significant difference in 90-day functional outcomes between groups (3.6±1.9 vs 3.5±2.6, p=0.82). Findings remained significant after adjustment where applicable. Conclusions: An aspiration-first CDCS strategy was associated with faster reperfusion and higher angiographic success without apparent safety trade-offs. Prospective comparative and cost-effectiveness studies are warranted.