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Introduction Mechanical thrombectomy is the treatment of choice for ischemic stroke due to large vessel occlusion. One common reason for failure or prolonged procedure time is vascular touristy inhibiting access to the site of occlusion. A novel device -the TracStar Large Distal Platform (LDP) -may offer improved navigation of tortuous vasculature as well as more distal final positioning when compared to commonly used guide catheters. We investigate the safety and efficacy of the TracStar LDP when used during mechanical thrombectomy. Methods We perform a multicenter retrospective review of mechanical thrombectomy procedures during which the TracStar LDP was utilized. Procedural information, complications, and key timepoints (groin puncture, clot-first-touch, etc.) were recorded as detailed in the operative note. Vascular tortuosity was assessed via pre-procedural CTA. Distal-most position achieved with TracStar was determined by review of intraprocedural imaging. Linear regression was performed to investigate the potential relationship between vascular tortuosity and procedure time. Results In a preliminary analysis of 20 cases, successful reperfusion (TICI 2b/3) was achieved in 88% of cases, requiring 1.8 passes on average (rage 1–5). Average NIHSS at presentation was 17.8 ± 6. Anterior circulation emboli were encountered in 15 cases. Average time to clot-first touch was 12± 7 minutes and average time to final reperfusion was 50 ± 27.6 minutes. Good functional outcome (mRS 0–2) at 90 days was achieved in 35% of cases. There was no association between vascular tortuosity and procedure time. There were no procedural complications, and TracStar LDP was exchanged for an alternative guide catheter in two cases due to failure to maintain positing. Conclusion Mechanical thrombectomy with the Tracstar LDP is safe and effective. Access beyond the horizonal petrous segment of the ICA was achieved in the majority of cases. Interestingly, ICA tortuosity was not associated with an increased time to clot-first-touched. Final analysis of 30 patients in this multi-center retrospective study will be available for presentation at the SNIS Annual Meeting 2020. Disclosures D. Bageac: None. R. De Leacy: None.

Introduction Increased procedure time during endovascular treatment of cerebral aneurysms is associated with increased anesthesia related complications and radiation exposure. Elimination of the need for intermediate catheters during aneurysm treatment may decrease procedure time and increase cost effectiveness. A novel device -the TracStar Large Distal Platform (LDP) -may offer more distal final positioning when compared to commonly used guide catheters, thus decreasing the need for guide catheter use. We investigate the safety and efficacy of the TracStar LDP when used during endovascular aneurysm treatment. Methods We perform a multicenter retrospective review of endovascular cerebral aneurysm embolizations during which the TracStar LDP was utilized. Aneurysm location, procedural information, and complications were recorded as detailed in the operative note. Vascular tortuosity was assessed via pre-procedural CTA. Distal-most position achieved with TracStar was determined by review of intraprocedural imaging. Results A preliminary analysis of 30 cases was performed. Flow diversion was performed in 25 cases (83%), and stent assisted coiling was performed in the remainder. The target aneurysm was located in the ICA in 27 cases (90%), the MCA bifurcation in 2 cases (7%), and the ACA in 1 case (3%). An intermediate catheter was required in 18 cases (60%). TracStar LDP achieved stable access to the Cavernous ICA in 70% of cases. Average procedure time was 67± 33 minutes.There were no procedural complications or new neurologic defects after treatment. TracStar LDP was exchanged for an alternative guide catheter in one case due to catheter kinking, and in two cases due to lack of support. Conclusion Use of Tracstar LDP during flow-diversion and sent-assisted coiling of cerebral aneurysms is safe and effective. Access to the cavernous segment of the ICA was achieved in the majority of cases, and use of an intermediate catheter was not required in 40% of cases. Final analysis of the the full 60 patient multi-center study will be available for presentation at SNIS Annual 2020. Disclosures D. Bageac: None. R. De Leacy: None.