Comparative in vitro study of five mechanical embolectomy systems: effectiveness of clot removal and risk of distal embolization

Abstract

Within limits, the experimental setup was appropriate for generating occlusions of diameter 2-5 mm of various lengths, simulating ICA, BA and MCA thromboembolism. In this model, thrombus mobilization appeared to be less dependent upon the individual design of the retrieval system than on thrombus fragmentation. The ability to prevent distal embolization is, however, strongly dependent on the ability of a thrombectomy device to capture fragments that are generated during removal of the device.

Mechanical Thrombectomy in Basilar Artery Thrombosis: Technical Advances and Safety in a 10-Year Experience

“…According to the data of Schulte-Altedorneburg et al [5], occlusion of the postcommunicating segment of one or both PCAs due to distal embolization occurs in 39 % of patients with successful intra-arterial fibrinolysis of the BA. In an in vitro study, Liebig et al [26] compared five embolectomy systems [Catch, Merci, InTime, and Attracter (Boston Scientific Corp, Natick, MA, USA) and Phenox clot retriever (Phenox GmbH, Bochum, Germany)] and found frequent thrombus fragmentation as well as thrombus migration in all devices. In another experimental study, it has been shown that mechanical embolectomy may cause even more embolic debris than chemical thrombolysis if used without flow reversal [27].…”

Endovascular Approaches to Acute Stroke, Part 1: Drugs, Devices, and Data

“…The Phenox retriever had a superior performance in terms of preventing distal embolization because it was able to capture most of these clot fragments. 60 This study needs to be interpreted in the context of its oversimplified methodology, which focused on the interaction between the thrombi and the devices but disregarded several other factors that are relevant to mechanical thrombectomy in humans. These include the interactions between the retriever devices and the vessel wall; the thrombus and the vessel wall; and the occurrence of endogenous thrombolysis, additional thrombosis, and vasospasm.…”

Mechanical Thrombectomy in Acute Ischemic Stroke: Catch Device

“…It has been demonstrated, in an animal model, 13,14 that the Catch device increased the risk of vessel wall irritation significantly and the number of distal embolic events compared with Merci (40% versus 10%) or Vasco35 retrieval (Balt). In the study by Liebig et al, 12 the Phenox retriever had a superior performance in terms of preventing distal embolization because it was able to capture most of these clot fragments. Embolization can be considerably reduced by using proximal balloon occlusion and aspiration during retrieval.…”

“…In a recent study comparing the performance of 5 different embolectomy systems, by using an in vitro pulsatile flow model, the Merci, Catch, and Phenox (Phenox, Bochum, Germany) retrievers were equally able to mobilize and remove most thrombi, whereas the InTime and Attractor (Boston Scientific, Natick, Massachusetts) devices achieved only a partial thrombus removal at best and with considerable difficulty during initial thrombus penetration and placement of the device. 12 To improve thrombus retrieval, we used the Catch in association with other endovascular treatment or IV rtPA (37/40 patients, 92%). The most frequent additional treatment was IV and/or IA rtPA (36/40, 90%), with a mean dose of 35 mg. Other therapies included thromboaspiration, angioplasty, and stent placement.…”