Initial experience with ultra-large-bore catheter aspiration for very large vessel occlusions

The vessels involved in very large vessel occlusions (VLVOs) have a lumen substantially larger than the diameter of intracranial thrombectomy catheters. As such, direct aspiration in VLVOs may only remove channels within the thrombus mass. Ultra-large bore catheters, 12 F or similar, have cross-sectional areas more comparable to those of the internal carotid artery and the superior sagittal sinus. The off-label use of these catheters may therefore maximize the potential for successful recanalization in VLVO. We report four cases of VLVO aspiration thrombectomy using a 12-F catheter. To our knowledge, this is the first reported use of this catheter in carotid artery occlusions. In this study, material use logs at two centers were reviewed to identify cases where aspiration thrombectomy for VLVO was performed using the Lightning 12 (Penumbra, Alameda, CA, USA). Patient demographics, imaging findings, and case details were collected and compared. Four patients were identified: two with superior sagittal sinus thrombosis and two with internal carotid artery occlusion. Aspiration with the Lightning 12 ultimately resulted in successful blood flow restoration for three patients. In the fourth case, the utility of the Lightning 12 was limited by a variant torcular. The only complication was the unsuccessful dual Perclose closure in case three. The off-label use of ultra-large-bore aspiration catheters may be an effective tool in VLVO thrombectomy. Further experience is needed.