Background Achieving radiographic reperfusion (TICI 3) in acute ischemic stroke thrombectomy may be an inadequate outcome measure. Unvisualized distal emboli even in the setting of TICI3 revascularization may lead to poor clinical outcomes. This study introduces a novel outcome metric, Complete Clot Ingestion (CCI). CCI is defined as full ingestion of the clot into the catheter or pump canister without any external clot remnants at the catheter tip. We hypothesizing that partially ingested (‘corked’) clots pose a higher risk of distal emboli.

Methods We evaluated two thrombectomy pump devices: the ALGO Smart Pump (Von Vascular, Inc, Sunrise, FL) and the Penumbra ENGINE Pump (Alameda, CA), focusing on their efficacy in achieving CCI using medium-bore aspiration catheters. The ALGO Smart Pump works by a novel mechanism of Adaptive Pulsatile Aspiration™ (APA). An in vitro model with a synthetic clot analog mimicking human thrombus was employed to conduct 300 thrombectomies across five catheters and the two pumps.

Results The ALGO Smart Pump demonstrated superior achievement of complete clot ingestion; CCI occurred in 80.0% of cases with the ALGO Smart pump compared to 38.6% with the Penumbra ENGINE Pump (p<0.001). In cases where CCI was achieved, thrombectomy pump and revascularization times were significantly reduced (p<0.001) and there were fewer distal emboli (p<0.001).

Conclusion Our findings suggest that the ALGO Smart Pump’s Adaptive Pulsatile Aspiration (APA™) mode significantly enhances complete clot ingestion (CCI) leading to reduced procedure time and distal emboli. This study supports the adoption of CCI as a valuable metric for assessing thrombectomy efficacy, and emphasizes the need for further clinical validation to confirm these in vitro results.

Disclosures R. Starke: None. J. Thompson: None. M. Silva: None. S. Sanikommu: None. A. Abdelsalam: None. J. Toledo: None. T. Elarjani: None. E. Jaman: None.