Large tube section is the key to successful coronary thrombus aspiration: Findings of a standardized bench test

Abstract

Thrombus removal by aspiration is one of the adjunctive techniques used to avoid embolization during PCI for acute myocardial infarction. Numerous devices are now available, but little is known about the mechanical rationale used in comparing them. The aim of the present study was to determine parameters to obtain optimal thrombus aspiration (TA). Heparin- and antiplatelet-free blood samples were aspirated into 3 mm diameter standardized glass tubes to create a 30 mm long thrombus. Thrombus formation took place at room temperature over a period of 6 or 12 hr. Various catheters were tested using a variable vacuum device: three with right-angle distal tip (0.038'', 0.067'', and 0.070'') and one with a beveled distal (length of the beveled, 0.054''; inner diameter catheter, 0.040''). The single endpoint was complete thrombus aspiration. A total of 103 TAs were presented for the four catheters. For 6- or 12-hr-old thrombus for a given catheter, there was no significant difference in vacuum pressure required to succeed TA (P = 0.47). For 6- or 12-hr-old thrombus, the larger the contact area is, the lower the pressure needed to aspirate the thrombus. Moreover, a beveled distal tip length (0.054'') does not make it possible to succeed TA at a lower pressure. The main factor for successful TA for thrombi > or = 6 hr is inner diameter and not immediate thrombus contact area.

Numerical Simulation of Thrombus Aspiration in Two Realistic Models of Catheter Tips

“…Indeed, such a tip is unlikely to be completely immersed within the thrombus and thus would preferentially aspirate blood instead of thrombus. In agreement with our findings, Rioufol and colleagues (19) recently found that to achieve a complete thrombus aspiration, a beveled tip requires a higher degree of vacuum than an unbeveled one (200 vs. 150 mbars).…”

Efficacy of beveled tip aspiration catheter in mechanical thrombectomy for acute ischemic stroke

“…There is evidence that a larger aspiration catheter tip surface area leads to an increase in aspiration power at the tip, an effect that has been postulated to be responsible for a higher first pass efficacy in cardiac thrombectomy. 22 23 However, there is some debate concerning the impact of larger bore catheters on outcomes. 24 In acute ischemic stroke, mechanical thrombectomy performed with the ACE68 catheters also demonstrated higher first pass efficacy compared with the early generation ACE60 and ACE64 catheters.…”

Direct aspiration using rapid‐exchange and low‐profile device for acute thrombo‐embolic occlusion of the superior mesenteric artery

“…Third, this large caliber equipment may result in access site complication and vessel wall injury of SMA and abdominal aorta. Recently, with the advancement of interventional technology, rapid‐exchange and low‐profile aspiration devices to have the ability to aspirate troublesome thrombus, crossability and flexibility have developed even for more small and tortuous coronary artery [8–10]. No previous report, however, has addressed the potential ability of this sort of aspiration device for SMA thrombo‐embolism.…”

“…The utility of direct aspiration has already been reported in various vascular thrombo‐embolic lesions since Greenfield et al reported the successful endovascular aspiration therapy [2–7]. Recently, the direct aspiration using rapid‐exchange and low‐profile aspiration device has been applied to complex thrombus in coronary artery, smaller and more tortuous vessel in the whole body [8–10]. We describe the utility of direct aspiration using this sort of aspiration device for failed thrombolysis of acute thrombo‐embolic occlusion of the SMA.…”