Mechanical Characterization of Thromboemboli in Acute Ischemic Stroke and Laboratory Embolus Analogs

Chueh, Juyu; Wakhloo, Ajay K.; Hendricks, Gregory H.; Silva, C.F.; Weaver, John P.; Gounis, M

doi:10.3174/ajnr.a2485

Cited by 162 publications

(156 citation statements)

References 24 publications

(35 reference statements)

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“…This enabled the evaluation of MET in a worstcase clinical scenario. Due to the variability in mechanical properties of thromboemboli from different sources, 12 testing with 1 clot model is a limitation of this study. Future work should continue to evaluate the efficacy and safety envelope of each device technology on the basis of embolus characteristics.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Mechanical Endovascular Thrombectomy in a Model System of Cerebrovascular Occlusion

Chueh

Wakhloo

Gounis

2012

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Mechanical Endovascular Thrombectomy in a Model System of Cerebrovascular Occlusion

Chueh

Wakhloo

Gounis

2012

AJNR Am J Neuroradiol

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“…Although this helps to identify the clot location easily on fluoroscopy and to determine its engagement into the destination vessel, it also weakens clot elasticity 3 and, in our experience, led to fragmentation (Fig. 3).…”

Section: Barium and Radiopacitymentioning

confidence: 90%

“…Previous models 3,6,11,15,20 have included the addition of barium during clot preparation to enhance the radiopacity of the clot. Although this helps to identify the clot location easily on fluoroscopy and to determine its engagement into the destination vessel, it also weakens clot elasticity 3 and, in our experience, led to fragmentation (Fig.…”

Section: Barium and Radiopacitymentioning

confidence: 99%

Development of a recalcitrant, large clot burden, bifurcation occlusion model for mechanical thrombectomy

Srinivasan¹,

Chen

Camstra³

et al. 2017

FOC

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OBJECTIVE Stroke is a major cause of disability and death in adults. Several large randomized clinical trials have shown the significant benefit of mechanical thrombectomy with modern stent retrievers in the treatment of large-vessel occlusions. However, large clots located at bifurcations remain challenging to treat. An in vivo model of these recalcitrant clots needs to be developed to test future generations of devices. METHODS Autologous blood was drawn from anesthetized swine via a femoral sheath. Blood was then mixed with thrombin, calcium chloride, and saline, and injected into silicone tubing to form cylindrical clots in the standard fashion. Matured clots were then delivered in an unfragmented fashion directly into the distal extracranial vasculature, at branch points where vessel sizes mimic the human middle cerebral artery, by using Penumbra aspiration tubing and the Penumbra ACE68 reperfusion catheter. RESULTS A total of 5 adult swine were used to develop the model. The techniques evolved during experiments in the first 3 animals, and the last 2 were used to establish the final model. In these 2 swine, a total of 8 autologous clots, 15–20 mm, were injected directly into 8 distal extracranial vessels at branch points to mimic a bifurcation occlusion in a human. All clots were delivered directly at a distal bifurcation or trifurcation in an unfragmented fashion to cause an occlusion. Ten revascularization attempts were made, and none of the branch-point occlusions were fully revascularized on the first attempt. CONCLUSIONS Using novel large-bore distal access catheters, large unfragmented clots can be delivered into distal extracranial vessels in a swine occlusion model. The model mimics the clinical situation of a recalcitrant bifurcation occlusion and will be valuable in the study of next-generation stroke devices and in training settings.

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“…In addition, we did not perform transesophageal echocardiography during Valsalva maneuver, which is reportedly useful for the detection of patent foramen ovale, 6) or lower extremity ultrasonography after thrombectomy due to exacerbation of the general condition. Therefore, deep venous thrombosis Fibrin-dominant thrombi with few red blood cell components have been reported to be hard, 9,10) but soft parts of the thrombus may have been fragmented by the two procedures using Trevo provue, and only the fibrin-rich part of the thrombus may have remained. Although the residual thrombus could not be recovered with a suction catheter, it could be fortunately recovered as the stent struts bit deep into it.…”

Section: Discussionmentioning

confidence: 99%

A Case of Mechanical Thrombectomy for Middle Cerebral Artery Occlusion with Trousseau Syndrome

Shinohara

Tsumura

Hasegawa

et al. 2017

JNET

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Objective and Case Presentation:The patient was an 86-year-old woman with histories of surgery for stomach, colon, and pancreatic cancers. In addition to left hemiparesis as a sequela of two past episodes of cerebral infarction, she newly developed right hemiplegia and acute cerebral infarction due to left middle cerebral artery (MCA) occlusion.Since the condition was not an indication for intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA), mechanical thrombectomy was immediately performed, and almost complete recanalization could be achieved about 5 hours after the onset. The retrieved thrombus was a white and elastic hard fibrin thrombus that contained no blood cells. Although temporary symptomatic relief was obtained, bilateral MCA occlusion occurred in succession, and the patient died on the 35th day of illness. Conclusion:Accumulation of cases and pathological evaluation of retrieved thrombi are necessary for the elucidation of the optimal mechanical thrombectomy or antithrombotic therapy for acute cerebral infarction due to Trousseau syndrome.

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Mechanical Characterization of Thromboemboli in Acute Ischemic Stroke and Laboratory Embolus Analogs

Cited by 162 publications

References 24 publications

Effectiveness of Mechanical Endovascular Thrombectomy in a Model System of Cerebrovascular Occlusion

Effectiveness of Mechanical Endovascular Thrombectomy in a Model System of Cerebrovascular Occlusion

Development of a recalcitrant, large clot burden, bifurcation occlusion model for mechanical thrombectomy

A Case of Mechanical Thrombectomy for Middle Cerebral Artery Occlusion with Trousseau Syndrome

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