A new era in thrombectomy: the emergence of super large bore aspiration catheters

• Super Large Bore Aspiration Catheters (SLACs) represent a new era in mechanical thrombectomy for acute ischemic stroke (AIS). With inner diameters (ID) of 0.088 in. or larger, SLACs offer enhanced thrombus ingestion rates and improved device-thrombus interaction, leading to more effective clot retrieval and shorter procedure times. Mechanical thrombectomy has significantly improved outcomes for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), yet challenges remain, necessitating further advancements. A key factor influencing thrombectomy success is the aspiration catheter-to-vessel size ratio, with larger-diameter aspiration catheters demonstrating superior efficacy. This has led to the development of super large-bore aspiration catheters (SLACs), particularly those with an inner diameter of 0.088 in. or larger, which are expected to enhance thrombus retrieval. SLACs have the possibility to revolutionize thrombectomy, especially for LVOs in critical arteries such as the internal carotid artery, the M1 segment of the middle cerebral artery. Recent clinical trials have shown highly favorable results, supporting their imminent adoption. With a bore size comparable to balloon guide catheters (BGCs), SLACs improve thrombus ingestion and reduce the risk of clot fragmentation during navigation through tortuous vessels. Additionally, they provide a stable base camp for multiple retrieval attempts, increasing procedural efficiency. Direct aspiration thrombectomy with SLACs offers advantages such as shorter procedural times, and reduced device usage. As these devices enter clinical practice, they are expected to further refine thrombectomy techniques and improve outcomes for AIS patients.