This expert discussion from ESOC 2026 explores the growing role of large bore aspiration catheters in mechanical thrombectomy and how evolving device technology is reshaping stroke intervention workflows. Featuring Dr. Razvan Radu (Bucharest) and Dr. Iain Rennie (Belfast), the conversation focuses on real-world experience using the SOFIA™ 88 system for the treatment of large vessel occlusion (LVO), particularly challenging carotid T occlusions and cases with high thrombus burden.

The faculty discuss the limitations of older-generation aspiration catheters, the rationale behind transitioning towards larger bore systems, and how improved vessel fit may enhance clot retrieval efficiency while reducing thrombus fragmentation and distal embolisation. Through practical case examples, they demonstrate how newer large bore aspiration techniques are enabling faster procedures, improved first-pass reperfusion rates, and simplified thrombectomy workflows.

The discussion also examines evolving procedural strategies including direct aspiration approaches, distal flow control, use of balloon guide catheters, tandem occlusions, and the role of adjunctive devices such as stent retrievers and support catheters. Importantly, the speakers address concerns surrounding vessel safety, procedural costs, and learning curves associated with adopting these newer technologies.

Overall, the session highlights how large bore aspiration systems are contributing to a new era of thrombectomy focused on procedural efficiency, faster recanalisation, and improved first-pass effect — key factors increasingly recognised as critical drivers of patient outcomes in acute ischemic stroke.

Recorded at ESOC 2026 as part of the ESOC TV Studios in partnership with Oruen.

Many thanks to Terumo for supporting this video.