Tenzing 7 Delivery Catheter Performance Across Tortuosity Indices.

Background: Early clinical experience with the Tenzing 7 delivery catheter (T7, Route 92 Medical, San Mateo, CA, USA) demonstrates high success rates for intracranial delivery of large bore aspiration catheters. Its soft, flexible, tapered tip mitigates the "ledge effect" that may cause resistance when navigating neurovascular devices through tortuous internal carotid arteries (ICAs) or other arterial branch origin variants. This study aims to characterize T7 performance across ICAs with varying tortuosities. Methods: A retrospective analysis was performed of prospectively collected data from patients with acute ischemic stroke treated with aspiration thrombectomy using T7 between January 2020 and July 2022 at 3 stroke centers. The ICA tortuosity index (TI) was derived from the ratio of actual to straight length measurements from anterior-posterior and lateral projections during digital subtraction angiography. T7 success is defined as delivering the aspiration catheter to the face of the occlusion. Regression analysis between TI and T7 success was performed. Correlations were calculated between TI, ICA grading, puncture-to-reperfusion time, number of passes, and final modified Treatment in Cerebral Infarction score. Significance was P ≤ 0.05. Results: Of 107 patients meeting inclusion, median age was 69 (interquartile range 60-81) years, and most occlusions were in the M1 segment (73/107; 68.2%). T7 rate of success was 95.3% (102/107), and there was no association between TI and T7 technical success (P = 0.23). Greater TIs and cavernous ICA tortuosity grades were not correlated with worse intraprocedural outcomes (P>0.24). Conclusion: In our multicenter experience, T7 performed well even in highly tortuous extracranial vasculature. Successful aspiration catheter delivery and intraprocedural performance were consistent irrespective of ICA tortuosity. Our findings support the use of T7 in aspiration endovascular thrombectomy for acute stroke for patients with tortuous extracranial vasculature.