Millipede Aspiration for Revascularization in Stroke (MARRS): prospective trial of a novel 0.088 inch corrugated catheter

BACKGROUND: The Millipede AspiRation for Revascularization in Stroke (MARRS) pivotal study was a prospective, multicenter, single arm trial evaluating the safety and efficacy of the corrugated Millipede catheter system in patients with acute ischemic stroke due to large vessel occlusion. METHODS: Patients aged 18-85 years with internal carotid artery, M1, M2, or basilar artery occlusions treatable within 8 hours were eligible. Catheter selection was based on target vessel diameter (Millipede88 >2.7 mm; Millipede70 >2.2 mm). The primary efficacy endpoint was modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b within ≤3 passes without rescue therapy. Imaging and clinical outcomes were independently adjudicated. Secondary endpoints included first pass effect (mTICI ≥2c). RESULTS: 180 patients were treated (57% US, 43% EU). Median age was 69 years, mean baseline National Institutes of Health Stroke Scale score was 17, and median Alberta Stroke Program Early CT Score was 9. M1 occlusion was the most common target lesion (62%). The primary endpoint was achieved in 160/180 patients (88.9%; 95% CI lower bound 84.3%) in the intention-to-treat cohort. Direct first pass aspiration was performed with Millipede88 and Millipede70 in 64% and 36% of patients, respectively. Navigation success was 96% with Millipede88 and 99% with Millipede70. Among Millipede88 patients, first pass mTICI ≥2c was achieved in 60%, increasing to 75% in the M1 subgroup. Final mTICI ≥2c was achieved in 85% of primary Millipede88 cases. Symptomatic intracranial hemorrhage occurred in 2.3%, intracranial dissection in 1.1%, no perforations occurred, and 90 day all cause mortality was 13.9%. CONCLUSIONS: The Millipede aspiration system demonstrated excellent deliverability and high rates of first pass and final mTICI ≥2c, particularly in M1 occlusions, with low rates of adverse events. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT05714501.

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Journal
Journal of NeuroInterventional Surgery
Published
2026-08-27
DOI
https://doi.org/10.1136/jnis-2026-025573
Primary Topic
Acute Ischemic Stroke Management
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article
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article

Millipede Aspiration for Revascularization in Stroke (MARRS): prospective trial of a novel 0.088 inch corrugated catheter

Sunil A. Sheth, Guillaume Bellanger, Grégory Gascou, Osama O. Zaidat et al.
Journal of NeuroInterventional Surgery
Acute Ischemic Stroke Management
article

Millipede Aspiration for Revascularization in Stroke (MARRS): prospective trial of a novel 0.088 inch corrugated catheter

Sunil A. Sheth, Guillaume Bellanger, Grégory Gascou, Osama O. Zaidat, Matthew T. Bender, Ricardó A. Hanel, Pedro Navía, Waldo R. Guerrero, Adnan Iqbal Qureshi, Alhamza R Al‐Bayati, Reza Dashti, Guilherme C. Dabus, Gaultier Marnat, Michael Nahhas, Xavier Barreau, Raul G. Nogueira, Marc Ribó, Ameer E Hassan, Christophe Cognard, Tareq Kass‐Hout, Charles Matouk, Eugene I. Lin, Manuel F. Granja, ryan priest, Mouhammad Jumaa, Alberto Álvarez-Muelas, Jaydevsinh Dolia, Francesco Diana, Benjamin Gory, Manuel Requena, Jose I Suarez, Ryan Hebert, Raoul Pop, Syed Zaidi, Sameer A Ansari, Romain Bourcier, Tarun Bhalla, Diogo C Haussen, Richard Burgess, Levansri D Makalanda, Nitin Goyal
article en

Abstract

BACKGROUND: The Millipede AspiRation for Revascularization in Stroke (MARRS) pivotal study was a prospective, multicenter, single arm trial evaluating the safety and efficacy of the corrugated Millipede catheter system in patients with acute ischemic stroke due to large vessel occlusion. METHODS: Patients aged 18-85 years with internal carotid artery, M1, M2, or basilar artery occlusions treatable within 8 hours were eligible. Catheter selection was based on target vessel diameter (Millipede88 >2.7 mm; Millipede70 >2.2 mm). The primary efficacy endpoint was modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b within ≤3 passes without rescue therapy. Imaging and clinical outcomes were independently adjudicated. Secondary endpoints included first pass effect (mTICI ≥2c). RESULTS: 180 patients were treated (57% US, 43% EU). Median age was 69 years, mean baseline National Institutes of Health Stroke Scale score was 17, and median Alberta Stroke Program Early CT Score was 9. M1 occlusion was the most common target lesion (62%). The primary endpoint was achieved in 160/180 patients (88.9%; 95% CI lower bound 84.3%) in the intention-to-treat cohort. Direct first pass aspiration was performed with Millipede88 and Millipede70 in 64% and 36% of patients, respectively. Navigation success was 96% with Millipede88 and 99% with Millipede70. Among Millipede88 patients, first pass mTICI ≥2c was achieved in 60%, increasing to 75% in the M1 subgroup. Final mTICI ≥2c was achieved in 85% of primary Millipede88 cases. Symptomatic intracranial hemorrhage occurred in 2.3%, intracranial dissection in 1.1%, no perforations occurred, and 90 day all cause mortality was 13.9%. CONCLUSIONS: The Millipede aspiration system demonstrated excellent deliverability and high rates of first pass and final mTICI ≥2c, particularly in M1 occlusions, with low rates of adverse events. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT05714501.

Journal of NeuroInterventional Surgery
Northwestern University (US), Baptist Hospital of Miami (US), Grady Memorial Hospital (US), Johns Hopkins University (US), Inserm (FR), Oregon Health & Science University (US), University of South Florida (US), Johns Hopkins Medicine (US), Hospital Universitario La Paz (ES), Royal London Hospital (GB), ProMedica Toledo Hospital (US), University of Rochester Medical Center (US), Centre Hospitalier Universitaire de Nantes (FR), Yale University (US), University of Chicago (US), Centre Hospitalier Universitaire de Montpellier (FR), Baptist Cancer Center (US), Baptist Health South Florida (US), UPMC Health System (US), Centre Hospitalier Régional et Universitaire de Nancy (FR), Hôpital Pellegrin (FR), Semmes Murphey Foundation (US), Imagerie Adaptative Diagnostique et Interventionnelle (FR), Vall d'Hebron Hospital Universitari (ES), Baptist Medical Center Jacksonville (US), Bon Secours Mercy Health (US), Valley Baptist Medical Center (US), Hôpital Purpan (FR), Neurological Surgery (US), CentraCare Health System (US), Stony Brook University (US), Université de Strasbourg (FR), Université de Lorraine (FR), The University of Texas Health Science Center at Houston (US)
Good health and well-being
Openalex Percentile: Top 10%
Acute Ischemic Stroke Management
DOIOpen Access PDFOpenAlex
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