In vitro experiments of cerebral blood flow during aspiration thrombectomy: potential effects on cerebral perfusion pressure and collateral flow

Lally, Frank; Soorani, Mitra; Woo, Timothy; Nayak, Sanjeev; Jadun, Changez; Yang, Ying; McCrudden, John; Naire, Shailesh; Grunwald, Iris Q.; Roffe, Christine

doi:10.1136/neurintsurg-2015-011909

Cited by 25 publications

(35 citation statements)

References 24 publications

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“…The flow restriction created by the ANCD is also restricted to the affected artery, minimizing the hemispheric flow arrest created by the use of a BGC positioned and inflated in the ICA. In addition, it is reasonable to assume that the power of aspiration will increase if the occluding catheter is positioned just proximal to the clot since there are in that case no large side branches between the catheter and the clot 24. When aspiration is performed from a BGC in the ICA, the aspiration force in the MCA may be lessened as it is shared with large branches such as the anterior cerebral artery or the posterior communicating artery.…”

Section: Discussionmentioning

confidence: 99%

ANCD thrombectomy device: in vitro evaluation

Sánchez¹,

Cortiñas²,

Villanova³

et al. 2019

J NeuroIntervent Surg

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IntroductionEndovascular treatment of stroke, although highly effective, may fail to reach complete recanalization in around 20% of cases. The Advanced Thrombectomy System (ANCD) is a novel stroke thrombectomy device designed to reduce clot fragmentation and facilitate retrieval by inducing local flow arrest and allowing distal aspiration in combination with a stent retriever. We aimed to assess the preclinical efficacy of ANCD.MethodsSoft red blood cell (RBC)-rich (n=20/group) and sticky fibrin-rich (n=30/group) clots were used to create middle cerebral artery (MCA) occlusions in two vascular phantoms. Three different treatment strategies were tested: (1) balloon guide catheter + Solitaire (BGC+SR); (2) distal access catheter + SR (DAC+SR); and (3) ANCD+SR, until complete recanalization was achieved or to a maximum of three passes. The recanalization rate was determined after each pass.ResultsAfter one pass, ANCD+SR resulted in an increased recanalization rate (94%) for all clots together compared with BGC+SR (66%; p<0.01) or DAC+SR (80%; p=0.04). After the final pass the recanalization rate increased in all three groups but remained higher with ANCD+SR (100%) than with BGC+SR (74%; p<0.01) or DAC+SR (90%; p=0.02). The mean number of passes was lower with ANCD+SR (1.06) than with BGC+SR (1.46) or DAC+SR (1.25) (p=0.01). A logistic regression model adjusted for treatment arm, clot type, and model used showed that both RBC-rich clots (OR 8.1, 95% CI 1.6 to 13.5) and ANCD+SR (OR 3.9, 95% CI 1.01 to 15.8) were independent predictors of first-pass recanalization.ConclusionIn in vitro three-dimensional models replicating MCA-M1 occlusion, ANCD+SR showed significantly better recanalization rates in fewer passes than other commonly used combinations of devices.

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Section: Discussionmentioning

confidence: 99%

ANCD thrombectomy device: in vitro evaluation

Sánchez¹,

Cortiñas²,

Villanova³

et al. 2019

J NeuroIntervent Surg

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“…It should be noted, however, that the dependent variable in these studies was flow, not suction force, which, as previously mentioned, does not accurately represent the action of catheter on clot. Computational flow and In vitro analyses have shown that aspiration forces are effective only if the catheter tip is in direct contact with the thrombus 11…”

Section: Discussionmentioning

confidence: 99%

A technical comparison of thrombectomy vacuum aspiration systems

Yaeger

Iserson

Singh

et al. 2019

J NeuroIntervent Surg

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IntroductionImproved functional outcomes after mechanical thrombectomy for emergent large vessel occlusion depend on expedient reperfusion after clinical presentation. Device technology has improved substantially over the years, and several commercial options exist for both large-bore aspiration catheters and suction pump systems.ObjectiveTo compare various vacuum pumps and examine the aspiration forces they generate as well as the force of catheter tip detachment from an artificial thrombus.MethodsUsing an artificial thrombus made from polyvinyl alcohol gel, we tested various mechanical characteristics of commercially available suction pumps, including the Penumbra Jet Engine, Penumbra Max, Stryker Medela AXS, Microvention Gomco, and a 60 cc syringe. Both aspiration pressure and tip force generated were analyzed. Subsequently, a cohort of thrombectomy catheters were assessed using the Penumbra Jet Engine to determine tip forces generated on an artificial thrombus. One-way analysis of variance was used to assess statistical significance.ResultsThe Penumbra Jet Engine system generated both the highest maximum aspiration pressures (28.8 inches Hg) and the highest tip force (23.68 grams force (gf)) on an artificial thrombus, with statistical significance compared with the other pump systems. Using the Jet Engine, the largest-bore catheter was associated with the highest tip force (32.12 gf). The overall correlation coefficient between catheter inner diameter and tip force was 0.98.ConclusionsThe Penumbra Jet Engine pump generates significantly higher vacuum pressures and tip forces than the other commercially available aspiration pump systems. Furthermore, catheters with a larger inner diameter generate higher tip suction forces on aspiration. Whether these mechanical features lead to improved clinical outcomes is yet to be determined.

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“…There is a variety of access catheters, ranging from small (5F-7F) guiding catheters to large-bore sheath catheters (8F) and BGCs, but there is no consensus about which access catheter is most suitable. 4,8,[11][12][13] Mechanical thrombectomy is becoming more common, and many interventionalists must decide which technique to choose. Because empiric data are lacking and large randomized prospective studies are needed to resolve this issue from a clinical point of view, we addressed this question with a simple technical approach.…”

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confidence: 99%

Balloon-Guide Catheters Are Needed for Effective Flow Reversal during Mechanical Thrombectomy

Nikoubashman¹,

Wischer²,

Hennemann³

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Blood flow management in the carotid artery during mechanical thrombectomy is crucial for safety and effectiveness. There is an ongoing discussion about whether balloon-guide catheters or large-bore sheaths are needed for effective flow management. We compared general flow characteristics of proximal aspiration through a large-bore sheath and a balloon-guide catheter in a porcine in vivo model. MATERIALS AND METHODS: We investigated blood flow in a porcine common carotid artery with and without aspiration (VacLok syringe and Penumbra pump, Pump MAX) through an 8F-long sheath and an 8F balloon-guide catheter. Blood hemodynamics were assessed via continuous duplex sonography. RESULTS: Average vessel diameter and baseline blood flow were 4.4 Ϯ 0.2 mm and 244 Ϯ 20 mL/min, respectively. For the 8F sheath, pump aspiration resulted in a significant flow reduction (225 Ϯ 25 mL/min, P Ͻ .001), but with a persisting antegrade stream. Manual aspiration resulted in collapse of the vessel in 2 of 7 measurements and oscillatory flow with antegrade systolic and retrograde diastolic components in the remaining 5 measurements. Net flow was antegrade (52 Ϯ 44 mL/min) in 3 and retrograde (Ϫ95 Ϯ 52 mL/min) in the remaining 2 measurements. For balloon-guide catheters, balloon inflation always resulted in flow arrest. Additional pump or manual aspiration resulted in significant flow reversal of Ϫ1100 Ϯ 230 and Ϫ468 Ϯ 46 mL/min, respectively (both, P Ͻ .001). CONCLUSIONS: Only balloon-guide catheters allow reliable blood flow arrest and flow reversal in combination with aspiration via syringes or high-flow pump systems. Aspiration through an 8F sheath results in either collapse of the vessel or oscillatory flow, which can result in a net antegrade or retrograde stream.

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In vitro experiments of cerebral blood flow during aspiration thrombectomy: potential effects on cerebral perfusion pressure and collateral flow

Cited by 25 publications

References 24 publications

ANCD thrombectomy device: in vitro evaluation

ANCD thrombectomy device: in vitro evaluation

A technical comparison of thrombectomy vacuum aspiration systems

Balloon-Guide Catheters Are Needed for Effective Flow Reversal during Mechanical Thrombectomy

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