Necessary Catheter Diameters for Mechanical Thrombectomy with ADAPT

Nikoubashman, Omid; Nikoubashman, Arash; Büsen, Martin; Wiesmann, Martin

doi:10.3174/ajnr.a5401

Cited by 49 publications

(29 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The ineffectiveness of contact aspiration alone has been previously reported 20. Larger bore aspiration catheters have been showing promise in recent clinical studies, but they were not investigated in this study 33…”

Section: Discussionmentioning

confidence: 84%

Development of an in vitro model of calcified cerebral emboli in acute ischemic stroke for mechanical thrombectomy evaluation

Johnson

McCarthy

Fahy

et al. 2020

J NeuroIntervent Surg

View full text Add to dashboard Cite

BackgroundCalcified cerebral emboli (CCEs) are a rare cause of acute ischemic stroke (AIS) and are frequently associated with poor outcomes. The presence of dense calcified material enables reliable identification of CCEs using non-contrast CT. However, recanalization rates with the available mechanical thrombectomy (MT) devices remain low.ObjectiveTo recreate a large vessel occlusion involving a CCE using an in vitro silicone model of the intracranial vessels and to demonstrate the feasability of this model to test different endovascular strategies to recanalize an occlusion of the M1 segment of the middle cerebral artery (MCA).MethodsAn in vitro model was developed to evaluate different endovascular treatment approaches using contemporary devices in the M1 segment of the MCA. The in vitro model consisted of a CCE analog placed in a silicone neurovascular model. Development of an appropriate CCE analog was based on characterization of human calcified tissues that represent likely sources of CCEs. Feasibility of the model was demonstrated in a small number of MT devices using four common procedural techniques.ResultsCCE analogs were developed with similar mechanical behavior to that of ex vivo calcified material. The in vitro model was evaluated with various MT techniques and devices to show feasibility of the model. In this limited evaluation, the most successful retrieval approach was performed with a stent retriever combined with local aspiration through a distal access catheter, and importantly, with flow arrest and dual aspiration using a balloon guide catheter.ConclusionCharacterization of calcified tissues, which are likely sources of CCEs, has shown that CCEs are considerably stiffer than thrombus. This highlights the need for a different in vitro AIS model for CCEs than those used for thromboemboli. Consequentially, an in vitro AIS model representative of a CCE occlusion in the M1 segment of the MCA has been developed.

show abstract

Section: Discussionmentioning

confidence: 84%

Development of an in vitro model of calcified cerebral emboli in acute ischemic stroke for mechanical thrombectomy evaluation

Johnson

McCarthy

Fahy

et al. 2020

J NeuroIntervent Surg

View full text Add to dashboard Cite

show abstract

“…However, in the case of mechanical thrombectomy by suction aspiration, the goal is for complete apposition of the catheter onto the thrombus, leading to flow arrest. In this case, the vacuum force exerted on the clot depends directly on the vacuum pressure generated within the lumen and the radius of the distal catheter tip ( true0F=PA ) 8. Therefore, given the flow arrest achieved during thrombectomy, catheter tip forces are independent of catheter length.…”

Section: Discussionmentioning

confidence: 99%

A technical comparison of thrombectomy vacuum aspiration systems

Yaeger

Iserson

Singh

et al. 2019

J NeuroIntervent Surg

View full text Add to dashboard Cite

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.

show abstract

“…3,6,11 The force at the catheter tip depends on only the catheter diameter and the applied pressure and is therefore not altered by resistors. 12 The flow, however, is highly influenced by additional resistors; thus, any additional tubing and valves should be avoided whenever a backward flow is desired. Minimizing the resistance in the aspiration system is crucial because the necessary flow rate of aspirated blood is rather high: When the aim is to reverse blood flow, antegrade flow in the respective artery should be surpassed.…”

Section: Aspiration Pumpsmentioning

confidence: 99%

“…Thus, the pump with its current tubing should not be used for flow control but rather for techniques in which the force at the catheter tip, not the flow, is essential (for example, ADAPT). 12…”

Section: Penumbra Pumpmentioning

confidence: 99%

Under Pressure: Comparison of Aspiration Techniques for Endovascular Mechanical Thrombectomy

Nikoubashman

Wischer

Hennemann

et al. 2018

AJNR Am J Neuroradiol

Self Cite

View full text Add to dashboard Cite

Sixty-milliliter VacLok vacuum pressure syringes and the Dominant Flex suction pump achieved high and constant flows likely sufficient to reverse blood flow during thrombectomy with an 8F sheath or balloon-guide catheter in the ICA and modern distal aspiration catheters in the MCA. The Pump MAX aspiration pump is dedicated for use with distal aspiration catheters and is unlikely to reverse blood flow in the ICA and MCA without balloon protection.

show abstract

Necessary Catheter Diameters for Mechanical Thrombectomy with ADAPT

Cited by 49 publications

References 17 publications

Development of an in vitro model of calcified cerebral emboli in acute ischemic stroke for mechanical thrombectomy evaluation

Development of an in vitro model of calcified cerebral emboli in acute ischemic stroke for mechanical thrombectomy evaluation

A technical comparison of thrombectomy vacuum aspiration systems

Under Pressure: Comparison of Aspiration Techniques for Endovascular Mechanical Thrombectomy

Contact Info

Product

Resources

About