The aspiration catheters, systems and methods include a catheter having an elongated body with a cross-section having a flat side and a curve near the distal end. The first side of the cross-section can contact a first side of a delivery lumen in a first orientation, and a second side of the cross-section contacts the first side of the delivery lumen in a second orientation rotated 180° from the first orientation. The curve can be directed 90° relative to a normal of the flat side. The systems and methods can utilize two catheters, and a key joint formed with the two catheters which can rotationally fix the catheters with respect to each other, and the first and second catheters each include at least one pre-formed curve near the distal end. The two catheters can be moved proximally and distally for positioning in the right and left bronchi.