Novel Distal Emboli Protection Technology: The EmboTrap

Abstract

Background: Over the course of the thrombectomy procedure, clot fragments may become dislodged and lead to downstream emboli due to manipulation of an endovascular device. The EmboTrap thrombectomy system features an inner stent channel with an outer stent trap design that may potentially reduce the risk of distal clot fragmentation during clot removal. We tested the hypothesis that distal emboli to both the same and new territory generated during mechanical thrombectomy are a function of device design. Methods: EmboTrap and Solitaire thrombectomy were conducted in an in vitro model system that mimicked a middle-cerebral artery (MCA) occlusion within a complete circle of Willis vascular replica and a contrast-enhanced clot analog. Emboli generated during the procedure with a size >1,000 μm were collected and measured with calipers. The Coulter principle was used to characterize emboli with a size between 200 and 1,000 µm. Results: EmboTrap thrombectomy resulted in a significant reduction in the risk of large emboli (>1,000 μm) formation as compared to first-generation stent retriever thrombectomy (p = 0.031, Fisher exact test). The majority of emboli >1,000 μm (∼80%) were found in the MCA, regardless of device type. There was no significant difference between the EmboTrap and Solitaire in 200 to 1,000 μm emboli formation (p = 0.89, Mann-Whitney test). When combining all emboli in the most dangerous range (>200 μm), EmboTrap offered a size reduction of emboli (p = 0.022). Conclusion: The risk of distal embolization can be altered with improved stent retriever design. When encountering fragment-prone clots, EmboTrap thrombectomy may lower the risk of distal embolization.

Posterior Circulation Occlusions May Be Associated with Distal Emboli During Thrombectomy

“…Other techniques have also been shown to reduce the incidence of distal emboli. For example, more distal deployment of stent retrievers can reduce distal emboli especially if the stent retriever is designed to function in that way [38]. The PROTECT technique which uses both a BCG and distal aspiration at the clot in addition to the stent retriever can also reduce thrombus fragmentation [39].…”

Thrombectomy using the EmboTrap device: core laboratory-assessed results in 201 consecutive patients in a real-world setting

“…The segmented outer cage is designed to trap a wide range of clot compositions inside the device while the inner channel provides immediate flow restoration, stabilizes the clot during retrieval, and breaks the pressure gradient between the proximal and distal ends of the clot. The closed distal end is designed to capture possible fragments and has been shown to significantly reduce large emboli from releasing compared with conventional stent retrievers 27. The articulated body and petals allow the outer cage to remain apposed to the vessel wall to optimize clot retention during retraction along branches and tortuous vessels.…”

Initial experience with the novel EmboTrap II clot-retrieving device for the treatment of ischaemic stroke

“…No embolism in distal or unaffected territory occurred. The articulating-petals-structure is specifically designed to avoid this event 22 that can be associated with severe clinical worsening.…”