Comparing different thrombectomy techniques in five large-volume centers: a ‘real world’ observational study

Hesse, Amélie Carolina; Behme, Daniel; Kemmling, André; Zapf, Antonia; Hokamp, Nils Große; Frischmuth, Isabelle; Maier, Ilko; Liman, Jan; Tsogkas, Ioannis; Buhk, Jan‐Hendrik; Tran, Julia; Fiehler, Jens; Mpotsaris, Anastasios; Schramm, Peter; Berlis, Ansgar; Knauth, Michael; Psychogios, Marios‐Nikos

doi:10.1136/neurintsurg-2017-013394

Cited by 58 publications

(48 citation statements)

References 27 publications

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“…The concept is to deploy the retriever and advance the aspiration catheter until it engages the clot. Relatively similar techniques have been described, mostly consisting of single-arm experiences10–13 and some comparative studies14–16 showing that it may be superior to either retriever or aspiration thrombectomy alone. The fundamental aim is to push the aspiration catheter slightly past the proximal end of the clot in order to ‘cork’ (partially ingest) the thrombus into the catheter.…”

Section: Discussionmentioning

confidence: 99%

Blind exchange with mini-pinning technique for distal occlusion thrombectomy

Haussen

Al‐Bayati

Eby

et al. 2019

J NeuroIntervent Surg

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IntroductionTechnical improvements to enhance distal occlusion thrombectomy are desirable. We describe the blind catheter exchange technique and report the pinning technique with small devices (‘mini-pinning’) for distal occlusions.MethodsA retrospective review of a prospective database from January 2015 to August 2018 was performed for cases of distal occlusion in which the ‘blind exchange/mini-pinning’ (BEMP) techniques were used. The technique involves the deployment of a 3 mm Trevo retriever followed by microcatheter removal and blind advancement of a 3MAX aspiration catheter over the bare retriever delivery wire (‘blind exchange’) until clot contact under aspiration. The retriever is subsequently partially recaptured in order to ‘cork’ the thrombus (‘mini-pinning’) and the system pulled as a unit. Patients with distal occlusions treated with BEMP and standard techniques (either 3 mm Trevo or 3MAX) were compared.ResultsTwenty-five vessels were treated in 22 patients. The majority of patients had isolated distal occlusions predominantly in the distal middle cerebral artery (MCA) segments, half of which involved the superior division. The comparison between BEMP (n=25 vessels) and standard techniques (n=144 vessels) revealed balanced groups. One of the highlighted differences was the more distal MCA occlusions among those who underwent BEMP (M3 occlusions 52% vs 22%; p=0.001). Otherwise, the vessel, segments, divisions and luminal diameter were comparable. There was a higher rate of first-pass modified Thrombolysis in Cerebral Infarction 2b–3 (80% vs 56%; p=0.03) and a trend towards higher rates of first-pass full reperfusion (60% vs 40%; p=0.07) with BEMP compared with standard techniques. Final reperfusion and clinical outcomes were comparable.ConclusionBEMP appears to be a safe and effective technique for the treatment of distal occlusions. Additional studies are warranted.

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Section: Discussionmentioning

confidence: 99%

Blind exchange with mini-pinning technique for distal occlusion thrombectomy

Haussen

Al‐Bayati

Eby

et al. 2019

J NeuroIntervent Surg

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“…Alteplase (rTPA), but this can be associated with problems such as risk of bleeding and is contraindicated in some instances such as pregnancy trauma, or postoperatively. Thrombectomy methods [2,3] include Mechanical Thrombectomy Devices (MTDs), aspiration devices or a combination of both [4][5][6][7][8][9][10][11], e.g. the MERCI (Mechanical Embolus Removal in Cerebral Ischemia), the Penumbra device, rheolytic catheters (Angiojet) are used.…”

Section: Introductionmentioning

confidence: 99%

Modeling of blood clot removal with aspiration Thrombectomy devices

Romero¹,

Talayero²,

Pearce³

et al. 2020

JMES

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Thrombectomy by aspiration is a highly effective method of accomplishing vessel recanalization. This study aims to obtain a mathematical model that allows the prediction of the dynamic response of a thrombus in response to different suction conditions, in order to avoid potential damage or the breakage of the clot during the interventional procedure. Virtual computing models have been created using Bond-Graph data and mass-spring Multi-Degree of Freedom equations. The model allows the use of tensile and torsion loads that could potentially be generated by the suction pressure together with different catheter geometries. The stress generated in the clot depends on its length and on its stiffness. The results obtained with the mathematical model are validated with a Finite Element Method (FEM) model, shows good agreement in terms of stress and elongation values. The results are consistent with previous Bond Graph models which indicated that the forces needed to extract a blood clot from an artery in in-vitro experiments are within the range used experimentally (~40-90 kPa). Qualitative experiments are undertaken with 3D printed scale prototypes and gelatin. The results are consistent with Computer Fluid Dynamic (CFD) simulations.

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“…The arteries that comprise the Circle of Willis in the human brain are among the vessels that are most frequently affected by stroke. In recent years, several devices and techniques have been employed in blood clot removal [2][3][4]. Mechanical Thrombectomy Devices (MTD) [5][6][7] have been compared to Aspiration Thrombectomy Devices [8][9][10] and the effectiveness of using both in combination has also been investigated [11].…”

Section: Introductionmentioning

confidence: 99%

Thrombectomy aspiration device geometry optimization for removal of blood clots in cerebral vessels

Talayero¹,

Romero²,

Pearce³

et al. 2020

JMES

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A study involving the removal of blood clots in cerebral vessels by aspiration thrombectomy is presented. A robust design for the distal end geometry of a catheter is obtained that, together with adequate suction conditions, could avoid potential damage in the artery or fragmentation the thrombus. The optimization process of the parameters is undertaken by a Design of Experiments (DOE) that has been prepared based on Robust Design theories. In particular, 27 experiments are run for one factor at 9 levels (catheter geometry) and up to 9 factors at 3 levels. The experiments are formulated with virtual models that are solved with computing tools. Co-simulation between Computer Fluid Dynamics (CFD) and Finite Elements Method (FEM) structural analysis was used to obtain the suction conditions and the behavior of the blood clot during the intervention process. By comparing the results of the 27 experiments, the highest values of the suctioning force are obtained for a hole pattern based catheter design, that also gives the lowest risk for clot damage (based on the stress value obtained). Direct aspiration and designs based on conical catheter distal ends, give less robust solutions (results are not stable when the conditions of the environment change). Our study investigated the distance between the catheter and the clot, and it was noted that if the catheter was far from the clot, the suction generated a vessel narrowing and consequent potential damage. Up to 90 kPa could be applied when suctioning at a maximum distance equal to the diameter of the vessel between the distal end of the catheter and the proximal end of the clot. A maximum suctioning force of 0,514N was achieved without damage to the artery or the clot. This research enables us to determine and use the most representative parameters and geometries to be tested in in-vitro and in-vivo experiments. In this virtual study, hypothesizes are assumed with regard to the material properties, but the robustness of the design process allows to expect similar results in future in-vitro and in-vivo tests.

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Comparing different thrombectomy techniques in five large-volume centers: a ‘real world’ observational study

Cited by 58 publications

References 27 publications

Blind exchange with mini-pinning technique for distal occlusion thrombectomy

Blind exchange with mini-pinning technique for distal occlusion thrombectomy

Modeling of blood clot removal with aspiration Thrombectomy devices

Thrombectomy aspiration device geometry optimization for removal of blood clots in cerebral vessels

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