A304 First-line aspiration thrombectomy with the RED43 catheter for acute ischemic stroke due to medium or distal vessel occlusion

<h3>Introduction</h3> Techniques for endovascular thrombectomy in acute ischemic stroke due to medium or distal vessel occlusions (MDVO) need to be improved, and first-line aspiration is emerging as a promising technique. <h3>Aim of Study</h3> The objective of this study was to describe first-pass and final reperfusion rates with a triaxial direct aspiration first pass technique (ADAPT) and a novel, quadriaxial technique (QUATTRO-ADAPT, see figure 1) using RED43 Reperfusion Catheters to target MDVOs. <h3>Method</h3> This retrospective study collected data from 11 stroke centers in Europe and North America between 2023 and 2025. Patients with primary, isolated MDVOs who underwent thrombectomy using first-line aspiration with RED43 Reperfusion Catheters were included. Primary outcome was first-pass successful reperfusion rate (mTICI 2b-3). Additionally, final reperfusion rates, complications and functional outcomes up to 90 days were evaluated. <h3>Results</h3> We included 85 cases in our analysis. Median age was 74 (IQR 67–81) years and median NIHSS score 9 points (IQR 6–15). The majority (69.4%) had an occlusion of the co- or nondominant M2 segment of the middle cerebral artery. Successful first-pass reperfusion was 63.5% overall, with 55.6% for the triaxial ADAPT and 69.4% for the quadriaxial QUATTRO-ADAPT. Final successful reperfusion was achieved in 96.5%. Complications included vessel perforations (2.4%), subarachnoid hemorrhage (3.5%), parenchymal hematoma type 2 (2.4%), and symptomatic intracerebral hemorrhage (1.2%). Functional independence (mRS 0–2) at 90 days was observed in 58.7%. <h3>Conclusion</h3> This study shows that first-line aspiration, especially in a quadriaxial approach, can be effective and safe. These findings should be evaluated in prospective trials. <h3>Conflict of Interest</h3> Yes MP: Grants from the Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783), ICARUS (32003B_220118) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Grants for the DISTAL trial from Stryker Neurovascular Inc., Medtronic Inc., Phenox GmbH, Penumbra Inc. and Rapid Medical Inc., Sponsor-PI SPINNERS trial (Funded by a Siemens Healthineers AG Grant), Research agreement with Siemens Healthineers AG, Local PI for the ASSIST, EXCELLENT, TENSION, COATING, SURF and ESCAPE-NEXT trials. Speaker fees: Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. VA, AA, AB, NN and NR: nothing to disclose.