PURPOSE:Large bore catheters are increasingly used in mechanical thrombectomy (MT) for large vessel occlusions (LVOs). OBJECTIVE:To evaluate the efficacy and safety of the super-large bore Cereglide 0.092" (C-92) catheter, featuring the largest inner diameter available. METHODS:A multicenter observational study was conducted across 12 comprehensive stroke centers in the United States. Efficacy outcomes included the first pass effect (FPE) and successful reperfusion. FPE was defined as a first MT pass achieving a modified Treatment in Cerebral Infarction (mTICI) score of ≥2c. Successful reperfusion was defined as final mTICI score ≥2c. Safety outcomes involved device-related complications, symptomatic intracranial hemorrhage (sICH), and inpatient mortality. Functional outcomes included modified Rankin Scale (mRS) score at discharge and delta National Institutes of Health Stroke Scale (NIHSS) score. RESULTS:Fifty patients were included. The most common LVO was the first segment of the middle cerebral artery in 31/50 cases (62%). The C-92 reached the thrombus in 41 patients (82%). Median puncture-to-thrombus and puncture-to-reperfusion times were 15 min (IQR 10-25) and 26 min (IQR 15-49), respectively. FPE was achieved in 25/50 (50%) cases, and in 25/41 (61%) cases when the C-92 reached the thrombus. Successful reperfusion occurred in 36/41 patients (88%). There were no vessel perforations, or sICH. Distal embolization occurred in 4/50 (8%) cases, and 4/50 (8%) died. The mRS score at discharge was 3 (IQR 2-6), and the delta NIHSS score was 8 (IQR 5-12). CONCLUSION:The C-92 catheter demonstrated a safe profile achieving an overall FPE rate of 50%, and favorable functional outcomes in 88% of cases.

Introduction The Flow Re-direction Endoluminal Device (FRED) is a novel flow diverter with a unique double stent design, with an inner stent composed of 48 nitinol wires, and an outer stent with 16 nitinol wires. It is designed for endovascular cerebral aneurysm treatment, although, limited data exist regarding in-stent stenosis (ISS) rates associated with FRED devices. Methods A registry encompassing two North American comprehensive stroke centers was the base of this study. We longitudinally assessed patients implanted with FRED devices, emphasizing baseline demographics, aneurysmal characteristics, procedural data, aneurysmal occlusion, and the incidence of ISS. Results In our cohort of 87 patients receiving 88 FRED devices, ISS occurred in 10.4% (9) of cases. Mild ISS (<50%) was noted in 8.0% (7) of patients, moderate ISS (50-75%) in 1.1% (1), and severe ISS (>75%) in 1.1% (1). Analysis indicated ISS in 17.0% (8) of patients with the FRED device and 5.7% (2) with the FRED-X device; all ISS cases in the FRED-X group were mild. Differences in ISS rates between device types were not significant (p = 0.122). Delayed thrombotic events were documented in 6.9% (6) of patients. Aneurysm occlusion rates, measured via the Raymond-Roy Scale (RRS), showed adequate occlusion (RRS 1 or 2) in 68.8% at 3 months, 74.6% at 6 months, and 89.3% at 12 months. Conclusions The study elucidates the efficacy and safety profile of FRED devices, presenting favorable aneurysm occlusion rates and low retreatment needs while underscoring the manageability of ISS.

BACKGROUND AND OBJECTIVES:Middle meningeal artery embolization (MMAE) is a safe and efficacious adjunct to surgical evacuation for symptomatic chronic subdural hematoma (cSDH). We evaluated the concomitant performance of MMAE with surgical evacuation in a single anesthetic session rather than a staged approach. METHODS:In this retrospective, multicenter cohort study, patients with cSDH who underwent MMAE and surgical evacuation during 1 anesthetic session from January 2020 through August 2024 were included. The primary endpoints were feasibility (technical success), safety (complication and mortality rates), and efficacy (radiographic improvement and modified Rankin Scale score ≤2). RESULTS:Among 157 patients (median age 74 years), 66% had unilateral cSDH and 34% had bilateral disease. Technical success was achieved in 153 patients (97.4%), with no major intraprocedural failures. The overall complication rate was 10.8%, including intraprocedural complications (ie, vessel injuries, cardiac arrest) in 4 patients (2.5%) and periprocedural adverse events in 13 patients (8.3%), including seizures, hemorrhages, respiratory failure, ischemic events, infections, and recurrent hematomas. The overall mortality rate was 12.7% (6 [3.8%] early postoperative deaths, 13 [8.3%] late unrelated deaths). Radiographic improvement was observed in 91.7% of patients, with 63.1% achieving ≥50% reduction in hematoma thickness at last available follow-up. At median follow-up of 54 days, 99/118 (83.9%) patients achieved or maintained functional independence (modified Rankin Scale ≤2). CONCLUSION:Single-session MMAE with concomitant surgical evacuation proved feasible and safe. Radiographic and clinical outcomes were favorable, without higher complication rates compared with staged approaches. Future prospective studies should clarify the long-term benefits, assess the impact on resource use and cost-minimization, and determine ideal patient-selection criteria for this integrated treatment strategy.

Introduction: Preliminary results demonstrated positive outcomes with the adjunct use of IV antiplatelets in patients presenting with large vessel occlusion secondary to underlying intracranial atherosclerosis (ICAS-LVO) undergoing mechanical thrombectomy (MT). We aimed to assess the outcomes of this approach in a prospective registry. Methods: This is a pre-specified secondary analysis of the RESCUE-ICAS registry, a prospective cohort study including patients with 50-99% residual intracranial stenosis or re-occlusion following MT. Patients were divided into three groups: MT alone, MT with adjunct IV antiplatelets, or MT with adjunct stenting. Periprocedural IV antiplatelets used in this study included tirofiban, eptifibatide, and cangrelor. Primary endpoint was modified Rankin scale (mRS) of 0-2 at 90 days. Statistical analysis included logistic regression model to assess the factors associated with good 90-day outcomes. Results: A total of 57 patients received periprocedural IV antiplatelets without stenting (group 1) compared to 182 patients who underwent MT alone (group 2) and 198 who underwent MT with adjunct stenting (group 3). Median age was 69 and 40.4% of patients were females. There was no significant difference in baseline demographic and clinical characteristics of patients in the IV antiplatelets group compared to groups 2 and 3. There was no significant difference in mRS 0-2 at 90 days between patients in the IV antiplatelets group compared to the MT alone group (19.3% vs 30.2% P=0.108). However, patients in the MT with adjunct stenting group had higher rate of 90-day mRS of 0-2 (42.4% vs 19.3%, P=0.001) compared to the IV antiplatelets group. On multivariable analysis, MT with adjunct stenting was independently associated with good 90-day outcome (AOR 3.946, 95% CI 1.845-8.439, P<0.001) (Table 1). Discussion: In patients presenting with ICAS-LVO, IV antiplatelets as an adjunct to MT was not associated with higher odds of favorable functional outcome compared to MT alone. Patients undergoing MT with adjunct intracranial stenting had better functional outcomes when compared to MT with IV antiplatelets group. Further studies are necessary to validate our findings in this unique stroke subgroup.

BackgroundWe investigated racial disparities in radiologic and clinical outcomes of patients after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) with or without evacuation surgery.MethodsThis multicenter retrospective study includes consecutive patients who underwent MMAE across 11 institutions in North America (10 in the United States and 1 in Canada). Patients were stratified using self-reported racial data. Outcomes of interest were complications, treatment failure/reoperations, resolution of hematoma, and functional independence at last follow-up. Multivariable regression models were used to assess and adjust for relevant confounders.ResultsA total of 557 patients underwent 663 MMAEs, including 323 White (58%), 150 Black (27%), 35 Hispanic (6%), 29 Asian (5%) patients, and 20 patients (4%) self-categorized as other/nondisclosed. The median age (interquartile range) of the cohort was 75 (65-81) years, and 412 (74%) patients were female. Middle meningeal artery embolization was the primary treatment for CSDH for 369 patients (66%) and adjunct treatment for 188 (34%). Black patients had a 51% lower likelihood of reoperation relative to other racial categories (adjusted odds ratio [OR] 0.49; 95% confidence interval [CI] 0.25-0.95, p = 0.034). White patients were twice as likely (11% difference; adjusted OR 2.24; 95% CI 1.43-3.51, p < 0.001) and Black patients 59% less likely (6% difference; adjusted OR 0.41; 95% CI 0.25-0.69, p = 0.001) to be independent at last follow-up.ConclusionThis study highlights significant racial disparities in outcomes after MMAE for CSDH, with or without evacuation surgery. White patients had higher reoperation rates but were more likely to be functionally independent at last follow-up. Black patients, despite better baseline functional status, had lower odds of functional independence postoperatively.

BACKGROUND AND OBJECTIVES:The Silk Vista Baby (SVB) flow diverter (FD) stent (Balt SAS) is the first device designed for treating distally located brain aneurysms. It can be delivered through a 0.017-inch ID microcatheter, enabling access to small, distal vessels. The aim of this study was to evaluate the effectiveness, safety, technical success, occlusion rate, and clinical outcomes of the SVB device. METHODS:This retrospective, multicenter study included data from 18 centers from November 2023 to September 2024. Procedures were performed by experienced neurointerventionalists following institutional standards of care. Outcomes analyzed included effectiveness, safety, and aneurysm occlusion rates. Descriptive analyses and Pearson χ 2 or Independent t -Test were used for statistical evaluation. RESULTS:A total of 95 patients, mean age 55.4 years, were included. A total of 31% of aneurysms were ruptured at admission. Most (58.3%) were located in the anterior circulation, and 45% had previous treatment, mainly coiling (69.4%). Complication rates were higher for ruptured aneurysms (24.1%) compared with unruptured ones (9.2%). Two deaths occurred, 1 (1.1%) related to the procedure. At discharge, 87% of patients had modified Rankin Scale ≤2. The latest follow-up showed overall complete/near-complete occlusion rates of 76.1%, with 81.14% for ruptured and 73.43% for unruptured aneurysms. Technical success was higher in unruptured cases (100% vs 93.1%). CONCLUSION:Our case series demonstrated the efficacy of the SVB with a high rate of technical success. The occlusion rates for ruptured cases are comparable with those of other FDs. However, the rates are lower for unruptured cases. This discrepancy is likely due to the characteristics of the aneurysms, particularly in the presence of side branches in bifurcation lesions. The SVB safety profile is similar to other FDs in unruptured cases, while the ruptured group presented more complications.

INTRODUCTION:Physicians aim to provide optimal care, considering patient experiences and satisfaction. Traditional in-clinic surveys assessing surgical experiences face numerous limitations, including response bias, and inadequate inclusion of diverse demographics. Social media is an emerging platform for patients to share their healthcare experiences, providing an alternative method for gathering patient feedback. This study explores the prevalent themes of moyamoya disease experiences shared on social media. METHODS:Posts containing "#moyamoya" and "#moyamoyawarrior" from Instagram, TikTok, and Twitter were analyzed. Posts unrelated to direct patient experiences were excluded. Relevant posts were categorized by themes and analyzed based on the platform, gender, and identity of the poster (patient or someone else). Chi-squared tests were used to determined significance of theme prevalence. RESULTS:Of the 1,005 social media posts analyzed, 63.8 % were by patients, and 75.0 % were by females. Most patients (83.0 %) had undergone one surgery. Instagram posts most often focused on Recovery/Rehabilitation (69.7 %), Survival (66.7 %), and Spreading Positivity (45.8 %), while TikTok posts more frequently discussed Survival (97.2 %), Recovery/Rehabilitation (81.3 %), and Spreading Positivity (84.1 %) (p < 0.001). Females were less likely to post on these themes than males, who discussed religious topics more frequently (p = 0.029). Patients discussed appearance (p < 0.001), resiliency (p = 0.002), and quality of life (p = 0.014) more than their loved ones. CONCLUSION:This study demonstrates social media's use among moyamoya patients, and can supplement traditional methods of obtaining patient feedback. Despite limitations, leveraging social media can enhance understanding patient needs, ultimately improving care quality for Moyamoya disease patients.

BACKGROUND AND OBJECTIVES:Single-session middle meningeal artery embolization (MMAE) combined with surgical evacuation is a rapidly emerging strategy in the treatment of chronic subdural hematoma (cSDH). However, the effect of different evacuation techniques within this approach remains unclear. METHODS:We conducted a retrospective multicenter cohort study across 8 US institutions of patients with cSDH who underwent single-session MMAE with concomitant surgical evacuation between 2018 and 2024. Surgical techniques were categorized as craniotomy or burr-hole evacuation (twist drill, electric drill, or subdural evacuating port systems). Primary outcomes included procedural time, adverse events, and early clinical outcomes. RESULTS:The 205 included patients (30.2% female) underwent 276 procedures (35 craniotomies, 241 burr-hole evacuations). The median patient age was 75 years, and 157 (76.6%) patients were functionally independent at baseline. Subdural characteristics were similar in the craniotomy (n = 26) and the burr-hole evacuation (n = 179) groups. Patients who underwent craniotomy had longer drainage durations ( P < .001) and longer operative times (209 vs 190 min, P = .015). Patients undergoing craniotomy were also less likely to be discharged by postoperative day 6 ( P = .040). Procedural mortality rates were low overall (0.4%) and did not differ significantly between groups. Early postoperative mortality rates (3.3% overall) were also comparable across both groups. Overall mortality was higher in craniotomy patients (34.3% vs 10.4%, adjusted odds ratio = 3.69; 95% confidence interval: 1.23-11.06; P = .019), mainly because of late mortality and not attributable to the index procedure. CONCLUSION:In this multicenter study of single-session MMAE with concomitant evacuation for cSDH, burr-hole-based techniques were associated with shorter operative times and with postprocedural patterns such as earlier drain removal, which correlated with earlier discharge. These findings support the preferential use of minimally invasive evacuation methods within the single-session paradigm when anatomically and technically appropriate.

Giant, partially thrombosed intracranial aneurysms (GPTIAs) remain among the most technically challenging cerebrovascular lesions to treat, particularly in patients with associated cranial nerve or brainstem compression. Unlike microsurgical clipping with or without decompression, endovascular coiling, parent vessel flow diversion, or parent vessel occlusion, intrasaccular embolization presents a unique opportunity for immediate aneurysm occlusion and reduction of mass effect without requiring long-term antiplatelets or parent vessel compromise. However, to date, no prior intrasaccular devices were available to treat GPTIAs, including the Food and Drug Administration-approved Woven EndoBridge device which could only accommodate aneurysms up to ∼11 mm in width. Here, we present the technical feasibility, safety, and efficacy of minimally invasive endovascular intrasaccular aneurysm embolization for GPTIAs with the novel saccular endovascular aneurysm lattice (SEAL) XL device engineered with a dual-layer mesh design and an expanded size matrix aneurysms up to 20 mm in diameter. Further data from larger prospective case series are needed to validate these promising initial findings.

BACKGROUND By 2030, nonacute subdural hematomas (NASHs) will likely be the most common cranial neurosurgery pathology. Treatment with surgical evacuation may be necessary, but the recurrence rate after surgery is as high as 30%. Minimally invasive middle meningeal artery embolization (MMAE) during the perioperative period has been posited as an adjunctive treatment to decrease the potential for recurrence after surgical evacuation. We evaluated the safety and efficacy of concurrent MMAE in a multi-institutional cohort. METHODS Data from 145 patients (median age 73 years) with NASH who underwent surgical evacuation and MMAE in the perioperative period were retrospectively collected from 15 institutions. The primary outcome was the rate of recurrence requiring repeat surgical intervention. We collected clinical, treatment, and radiographic data at initial presentation, after evacuation, and at 90-day follow-up. Outcomes data were also collected. RESULTS Preoperatively, the median hematoma width was 18 mm, and subdural membranes were present on imaging in 87.3% of patients. At 90-day follow-up, median NASH width was 6 mm, and 51.4% of patients had at least a 50% decrease of NASH size on imaging. Eight percent of treated NASHs had recurrence that required additional surgical intervention. Of patients with a modified Rankin Scale score at last follow-up, 87.2% had the same or improved mRS score. The total all-cause mortality was 6.0%. CONCLUSION This study provides evidence from a multi-institutional cohort that performing MMAE in the perioperative period as an adjunct to surgical evacuation is a safe and effective means to reduce recurrence in patients with NASHs.

OBJECTIVE:Patient outcomes in medicine vary significantly when stratified by socioeconomic status (SES). In the cerebrovascular area specifically, rates of treatment of intracranial aneurysms (IAs) and overall outcomes after subarachnoid hemorrhage vary significantly by SES. Less is known about the effect of SES on the selection of seemingly equivocal treatment modalities (microsurgery vs endovascular embolization) for IAs. In this study, the authors examined the impact of SES as measured by the Area Deprivation Index (ADI) on selection of the treatment modality for anterior communicating artery (ACoA) aneurysms, which are readily amenable for either microsurgical or endovascular treatment. METHODS:A retrospective study was conducted on 136 consecutively treated patients with ACoA aneurysms, unruptured and ruptured, between August 2016 and February 2023 at a large, urban, academic hospital led by dual-trained neurosurgeons. A retrospective review of patient demographics, comorbidities, aneurysm size, morphology, and treatment selection was performed. Univariable and multivariable logistic regression analysis of treatment selection was conducted in the unruptured context, an elective setting, where socioeconomic factors play a strong role in patient-provider shared decision-making, versus the ruptured context, an emergency setting, where the need for expedient intervention diminishes the weight of socioeconomic considerations. RESULTS:Multivariable logistic regression showed that being a patient in the top 50th ADI percentiles was strongly associated with undergoing microsurgical treatment of an ACoA aneurysm in the unruptured context (OR 10.88, 95% CI 1.37-86.59; p = 0.02). Conversely, in the context of ruptured ACoA aneurysms, ADI was not associated with treatment selection (OR 0.16, 95% CI 0.02-1.27; p = 0.08). CONCLUSIONS:ADI significantly impacts treatment selection in the management of unruptured ACoA aneurysms. This study highlights that there might be indirect socioeconomic barriers biasing patients from lower SES backgrounds away from endovascular treatment of unruptured ACoA aneurysms compared with their higher SES counterparts.

BACKGROUND: Underlying intracranial stenosis is the most common cause of failed mechanical thrombectomy in patients with acute ischemic stroke with large vessel occlusion. Adjunct emergent stenting is sometimes performed to improve or maintain reperfusion, despite limited data regarding its safety or efficacy. METHODS:We conducted a prospective multicenter observational international cohort study. Patients were enrolled between January 2022 and December 2023 at 25 thrombectomy-capable centers in North America, Europe, and Asia. Consecutive patients treated with mechanical thrombectomy were included if they were identified as having underlying intracranial stenosis, defined as 50% to 99% residual stenosis of the target vessel or intraprocedural reocclusion. The primary outcome was functional independence, defined as a modified Rankin Scale score of 0 to 2 at 90 days. After applying inverse probability of treatment weighting based on propensity scores, we compared outcomes among patients who underwent adjunct emergent intracranial stenting (stenting) versus those who received mechanical thrombectomy alone. RESULTS: A total of 417 patients were included: 218 patients treated with mechanical thrombectomy alone (168 anterior circulation) and 199 with mechanical thrombectomy plus stenting (144 anterior circulation). Patients in the stenting group were less likely to be non-Hispanic White (51.8% versus 62.4%, P=0.03) and less likely to have diabetes (33.2% versus 43.1%, P=0.037) or hyperlipidemia (43.2% versus 56%, P=0.009). In addition, there was a lower rate of IV thrombolysis use in the stenting group (18.6% versus 27.5%, P=0.03). There was a higher rate of successful reperfusion (modified Treatment in Cerebral Infarction score >= 2B) in the stenting versus mechanical thrombectomy-alone group (90.9% versus 77.9%, P<0.001) and a higher rate of a 24-hour infarct volume of <30 mL (n=260, 67.9% versus 50.3%, P=0.005). The overall complication rate was higher in the stenting group (12.6% versus 5%, P=0.006), but there was not a significant difference in the rate of symptomatic hemorrhage (9% versus 5.5%, P=0.162). Functional independence at 90 days was significantly higher in the stenting group (42.2% versus 28.4%, adjusted odds ratio, 2.67 [95% CI, 1.66-4.32]). CONCLUSIONS: In patients with underlying stenosis who achieved reperfusion with mechanical thrombectomy, adjunct emergent stenting was associated with better functional outcome without a significantly increased risk of symptomatic hemorrhage.

INTRODUCTION: Multiple preferences exist in terms of embolic materials preferences in middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH) with limited comparative literature data. METHODS: Consecutive patients undergoing MMAE for cSDH at 14 North-American centers (2018-2023) were included. Patients were classified into 3 groups a) particles, b) Onyx, c) n-BCA. The endpoints were unplanned rescue surgery and radiographic success (=50% reduction in hematoma thickness at last imaging "minimum 2-weeks"). Initial unmatched analysis compared the 3 groups. Subsequent matched analysis via propensity score matching (PSM) compared particles versus liquid group (groups b & c combined; Onyx/n-BCA). Additional subgroup PSM analyses compared particles vs Onyx, particles vs n-BCA, Onyx vs n-BCA. All matched analyses controlled for: age, sex, concurrent surgery, prior surgery, hematoma thickness, midline shift, pre-treatment antithrombotics, baseline mRS. RESULTS: 872 patients (median-age 73 years, 72.9% males) underwent 1070 MMAE procedures (22.8% bilateral). Median cSDH thickness was 14 mm (IQR 10-18), with median midline shift 3mm (IQR 0–5.5). Onyx was the most utilized material (41.4%) followed by particles and n-BCA (40.3% and 15.5%, respectively). Retreatment rates were not different between particles, Onyx, n-BCA (9.8% vs 7% vs 11.7% respectively, p=0.14). Similarly, radiographic success rates were comparable (78.8% vs 79.3% vs 77.4% respectively, p=0.91). The PSM comparing particles vs liquid generated 128 matched-pairs; no significant differences in retreatment rates (11.7% vs 10.9%; p=0.84), or radiographic success (74.5% vs 74.5%; p=0.73). Concurrently, the PSM comparing Onyx vs n-BCA resulted in 42 matched pairs; without differences in radiographic improvement between the groups (67.7% vs 76.5%; p=0.42), or surgical rescue rates (11.9% vs 9.5%; p=0.72). No differences in procedural complications were noted between the groups across the previous analyses. CONCLUSIONS: We found no significant differences in clinical and radiographic efficacy between the particles and the liquid embolics in MMAE.

BackgroundMechanical thrombectomy with stent retrievers has become a standard treatment for acute ischemic stroke due to large vessel occlusion. Here we present a multicenter US experience using the EmboTrap III stent retriever, the latest iteration within its class.MethodsWe retrospectively reviewed patients with acute ischemic stroke treated with the EmboTrap III device at 4 US centers. We recorded baseline demographics, clinical characteristics, and procedural details. Outcomes included first-pass effect (FPE), modified FPE (mFPE), final mTICI scores, 90-day functional outcomes, and complications.ResultsA total of 92 patients were included, median age of 72 years, and 56.5% were women. The mean NIHSS on admission was 16.6 ± 8.1 and the median ASPECTS score was 9. IV thrombolysis was administered in 34.1%. Median last known normal to reperfusion time was 304 min. Final successful reperfusion (mTICI ≥ 2b) was achieved in 91.3% of patients. FPE (mTICI ≥ 2c after a first pass with the device) was achieved in 53.3% of patients, and mFPE (mTICI ≥ 2b after a first pass with the device) was achieved in 79.3% of patients. At 90 days, 22.9% of patients had modified Rankin Scale (mRS) ≤ 2. There were no device-related complications.ConclusionIn this multicenter study, the EmboTrap III achieved high final recanalization success and FPE/mFPE rates with low complication rates.

INTRODUCTION:While revascularization rates have improved for mechanical thrombectomy (MT) in acute ischemic stroke, advancements in aspiration pumps have been limited. The ALGO Smart Pump (Von Vascular, Sunrise, FL) is a small on-field, operator-driven pump offering two aspiration modes: Adaptive Pulsatile Aspiration (APA™) Mode and a continuous 'Static' mode. This study evaluates the performance of the ALGO Smart Pump's Static Mode compared to a commercially available aspiration pump. METHODS:Operators performed aspiration thrombectomy in a flow model with ALGO and the Penumbra ENGINE (Penumbra, Alameda, CA) using medium (ID.036-.057") to large (ID.068-.071) bore aspiration catheters. Primary endpoint was complete clot ingestion (CCI), defined as the full ingestion of the clot within the catheter or pump's canister, without any clot at the catheter tip or evidence of embolization to new territories (ENT). Secondary endpoints included first pass recanalization, ENT and total aspiration time. RESULTS:When comparing all catheters, ALGO Smart Pump achieved CCI in 154 of 180 thrombectomies (85.6 %) compared to Penumbra ENGINE achieving CCI in 136 of 180 thrombectomies (75.6 %). The CCI rate between pump types across all catheters was statistically significant (p = 0.008), favoring ALGO pump. There was no difference between pump type on aspiration time. CONCLUSION:The ALGO Smart Pump may represent an alternative in MT, with potential higher effectiveness compared to existing available aspiration pumps with additional user-friendly benefits including a sterile, smaller, on-field apparatus.