Optimizing endovascular stroke treatment: removing the microcatheter before clot retrieval with stent-retrievers increases aspiration flow

Abstract

The BWT technique results in improved aspiration flow rates compared with the standard deployment technique. Our clinical data show that the BWT technique is effective and safe.

Continuous aspiration prior to intracranial vascular embolectomy (CAPTIVE): a technique which improves outcomes

“…This has been shown experimentally to significantly increase the suction force 9. Again, we monitor the drip rate on the aspiration tubing to ensure near stasis.…”

Under Pressure: Comparison of Aspiration Techniques for Endovascular Mechanical Thrombectomy

“…The aspiration flow (milliliters/second) was obtained by dividing the collected volume by the aspiration time. 5 Aspiration with a syringe was assessed as aspirated volume with time. For measurements through the sheath and balloon catheter, we used an ultrasonic flow meter (HT110 Bypass Flowmeter & Tubing Sensor; Transonic, Ithaca, New York), due to the high flow through these catheters.…”

“…1 In past years, the focus of neurointerventional stroke research has shifted from establishing the method to finding the optimal treatment technique. [2][3][4][5][6] Effective blood flow management during the procedure is key to safety and effectiveness. 7 Chueh et al 2 have shown that there are thousands of small clot fragments during thrombectomy that may occlude small arterioles and capillaries.…”

Comparison of Vacuum Pressures and Forces Generated by Different Catheters and Pumps for Aspiration Thrombectomy in Acute Ischemic Stroke

“…In that scenario, suction force would only be minimally impacted by the slight reduction in transmitted vacuum pressure. Therefore, it would seem that the microcatheter does not need to be removed completely, as others have advocated with the “bare-wire thrombectomy” technique [19], but rather simply be pulled back so that the microcatheter tip is proximal to the aspiration catheter tip.…”

“…When using such a coaxial approach, the stent retriever delivery microcatheter may partially occlude the aspiration catheter and thereby potentially reduce the vacuum force. Therefore, some have recommended a “bare-wire thrombectomy” technique wherein the delivery catheter is removed prior to aspiration and thrombectomy [19]. These authors have also assessed flow rates through the aspiration catheter with and without the microcatheter in place (Poiseuille fluid dynamics), but have not assessed the static suction force in this scenario.…”