E-112 How do clots respond to direct aspiration during interventional treatment of acute ischemic stroke

Abstract

10 cases out of a pool of 22 case scenarios and asked how they would treat the patient A) assumed there were no economical or infrastructural constraints, and B) given their current working conditions. Subgroup analyses were performed for female and male physicians respectively. Results 607 physicians (97 women, 508 men, 2 who did not disclose their sex), of different specialties (326 neurologists, 173 interventional neuroradiologists, 81 interventional neurosurgeons, 2 geriatricians, 5 internists, 20 other) from 38 countries participated in this survey. 6070 responses were obtained. Neurologists constituted the largest group of both female (76.3%) and male (49.2%) physicians, with a more even distribution of specialties in male physicians. Assuming ideal conditions, no significant differences in EVT decision making was observed (EVT was favored by 77% of female and 79.3% of male physicians). Under their current working conditions, female physicians decided less frequently in favor of EVT (69.1%) as compared to their male colleagues (76.9%, p<0.001). Conclusion Under the ideal conditions, EVT decision between male and female physicians did not differ. Current working conditions restricted female physicians' endovascular treatment decision to a greater degree as compared to their male colleagues, resulting in a significantly lower decision rate in favor of EVT.

Cyclical aspiration using a novel mechanical thrombectomy device is associated with a high TICI 3 first pass effect in large‐vessel strokes

“…An oscillating pattern of aspiration (i.e., cyclical aspiration) may allow for dynamic stretching of the clot (within the elastic limits) that can decrease the OD of the clot to become dimensionally a closer fit to the ID of the aspiration catheter. This may help to promote complete clot ingestion by improving the dimensional fit and reducing clot fragmentation by staying within the elastic limits; 13,34,35 (2) Reducing Frictional Forces. Dynamic or kinetic friction is less than static friction 36 .…”

“…In addition, the active component of the stent retriever might cause vessel wall injury 12,30,31 or clot fragmentation, 13,32,33 This may help to promote complete clot ingestion by improving the dimensional fit and reducing clot fragmentation by staying within the elastic limits; 13,34,35 (2) Reducing Frictional Forces. Dynamic or kinetic friction is less than static friction.…”

“…This may be one of the reasons for the increased clot ingestion length observed with cyclical aspiration compared to static or continuous uniform aspiration. 13 With the mounting preclinical evidence in favor of cyclical aspiration, 12,13,30,31,35,37 the strengths of the CLEAR-1 cohort include it being the first clinical experience of cyclical aspiration for large-vessel strokes using the CLEAR TM Aspiration System. The most demanding metric for stroke thrombectomy namely FPE (TICI 3 FPE and TICI 2c/3 FPE) was used as the primary outcome measure.…”

REACT Aspiration Catheters: Clinical Experience and Technical Considerations

“…• Static versus cyclical aspiration mode: the constant pressure delivered by conventional aspiration syringes and pumps is referred to as the static or continuous uniform aspiration. Increasing aspiration cycle frequency (pressure oscillations per second, Hz) can improve the efficacy of clot removal [ 26 ], as cyclical aspiration may be able to induce larger strain on the clots [ 27 ]. Clinical studies reported that cyclical aspiration, also known as pulsatile or intermittent aspiration, could be more effective than continuous uniform aspiration to achieve FPE [ 28 , 29 ].…”

“…Increasing aspiration cycle frequency (pressure oscillations per second, Hz) can improve the efficacy of clot removal, 26 as cyclical aspiration may be able to induce larger strain on the clots. 27 Clinical studies reported that cyclical aspiration, also known as pulsatile or intermittent aspiration, could be more effective than continuous uniform aspiration to achieve FPE. 28,29 • The utilization of balloon guide catheter: the combined effect of proximal flow arrest and distal aspiration can reduce the number of passes, time from puncture to recanalization, and periprocedural embolization.…”