Stent retrievers with segmented design improve the efficacy of thrombectomy in tortuous vessels

Kaneko, Naoki; Komuro, Yutaro; Yokota, Hajime; Tateshima, Satoshi

doi:10.1136/neurintsurg-2018-014061

Cited by 49 publications

(39 citation statements)

References 28 publications

(10 reference statements)

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“…Nevertheless, the study adds additional information to the current knowledge of MTB and could serve as a basis for the development of diagnostic tools in the future, thus enabling the operators to evaluate the AOI using preprocedural imaging in order to select the most adequate MTB technique. Furthermore, prediction of the location of the clot could allow the selection of the most effective thrombectomy device and the optimal interaction between the clot and the device used for MTB, improving the rate of first pass recanalization irrespective of the thrombectomy technique used 29–31…”

Section: Discussionmentioning

confidence: 99%

Direct thromboaspiration efficacy for mechanical thrombectomy is related to the angle of interaction between the aspiration catheter and the clot

Bernava

Rosi

Boto

et al. 2019

J NeuroIntervent Surg

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BackgroundDirect thromboaspiration has been reported as an effective mechanical treatment for acute ischemic stroke. We aimed to determine whether the angle of interaction between the aspiration catheter and the clot affects the success of clot removal in ischemic stroke patients with large vessel occlusion in the anterior and posterior circulation.MethodsAll patients treated at our institution by direct thromboaspiration as a firstline technique between January 2016 and December 2017 were enrolled in the study. We retrospectively reviewed baseline and procedural characteristics, the angle of interaction formed between the aspiration catheter and the clot, the modified Thrombolysis in Cerebral Infarction score, and the 3 month modified Rankin Scale score.Results85 patients underwent direct thromboaspiration as the firstline treatment during the study period. 100 direct thromboaspiration passes were performed. An angle of interaction of ≥125.5° significantly influenced the success of clot removal (P<0.001) with good sensitivity and specificity, in particular for occlusion of the middle cerebral and basilar artery. The combination of aspiration with a stent retriever based thrombectomy was a valid rescue treatment in cases of standalone direct thromboaspiration failure.ConclusionsIn our series, an angle of interaction between the aspiration catheter and the clot of ≥125.5° was significantly associated with successful clot removal. The prediction of the angle of interaction on pretreatment imaging may help operators to select the most adequate mechanical thrombectomy technique on a case by case basis.

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Section: Discussionmentioning

confidence: 99%

Direct thromboaspiration efficacy for mechanical thrombectomy is related to the angle of interaction between the aspiration catheter and the clot

Bernava

Rosi

Boto

et al. 2019

J NeuroIntervent Surg

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show abstract

“…They reported that the segments of an Embotrap (Cerenovus, Galway, Ireland) and Versi Retriever (NeuroVasc Technologies, Laguna Hills, CA, USA), which have a segmented design, remained even in a markedly flexed blood vessel, improving the recanalization rate. 17) In the present case, ADAPT was also performed to treat embolism of the cervical ICA, but the thrombus captured with an ACE60 came off at the site of DICA, making retrieval impossible. Mascitelli et al compared patients in whom ADAPT was successful with those in whom it was unsuccessful, and reported that factors for poor recanalization after ADAPT included a larger number of flexed blood vessels, larger vascular diameter, vascular diameter greater than that of a catheter, and a low clot burden score as an index for evaluating thrombus-occluded blood vessels.…”

Section: Disclosure Statementmentioning

confidence: 77%

A Case Report Using Goose Neck Microsnare for Severe Cervical Internal Carotid Artery Occlusion with Dolichoarteriopathy

Kuwajima

Hirotaka

Nakajo

et al. 2021

JNET

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We report the use of a Goose Neck microsnare for cervical internal carotid artery (ICA) occlusion in a patient with dolichoarteriopathy in whom it was difficult to achieve recanalization.Case Presentation: A 65-year-old woman underwent thrombectomy for a tandem lesion of left M1 occlusion and left cervical ICA occlusion. Recanalization of left M1 occlusion was achieved. For left cervical ICA occlusion, we attempted multiple thrombectomy using an existing device, but a hard clot with mobility was caught due to dolichoarteriopathy, which made thrombectomy difficult. Using a Goose Neck microsnare, we were able to capture the thrombus and achieve recanalization. Conclusion:Thrombectomy by capturing the thrombus using a Goose Neck microsnare may be useful for capturing hard clots with mobility when it is difficult to achieve recanalization with existing devices.

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“…Generally, vascular tortuosity highly influences prompt endovascular access and clot retrieval during MT. 7,8 For instance, ICA siphon and the V3 segment of the VA, which represent innate vessels at an acute angle, would increase the complexity of navigating and retrieving the device. Conversely, if the vascular angle and vessel calibre are appropriate anatomically, MT can be possible even in a collateral pathway.…”

Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy utilising a collateral pathway in a patient with dysgenesis of the internal carotid artery

et al. 2018

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We describe a case of acute middle cerebral artery occlusion in a patient with ipsilateral internal carotid artery dysgenesis successfully treated with mechanical thrombectomy utilising a collateral pathway. During the procedure, a triaxial system using a balloon guiding catheter, flexible large lumen aspiration catheter and stent retriever was advanced from the left vertebral artery to the occluded left middle cerebral artery through the left posterior communicating artery. Because proximal aspiration from the balloon guiding catheter alone might have insufficient suction force due to the retrograde blood flow from large vascular communications (e.g. vertebral artery union), the tip of the flexible large lumen aspiration catheter was set at the proximal left middle cerebral artery, and distal aspiration was added during stent retrieval. A thrombolysis in cerebral infarction 2b result was achieved after the first pass. In this case, identification of carotid canal hypoplasia on computed tomography allowed for an immediate attempt of this alternative approach, avoiding a delay in the time to reperfusion.

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Stent retrievers with segmented design improve the efficacy of thrombectomy in tortuous vessels

Abstract: ESCAPE NCT01778335;SWIFT PRIME > NCT01657461; REVASCAT > NCT01692379; All post-results.

Cited by 49 publications

References 28 publications

Direct thromboaspiration efficacy for mechanical thrombectomy is related to the angle of interaction between the aspiration catheter and the clot

Direct thromboaspiration efficacy for mechanical thrombectomy is related to the angle of interaction between the aspiration catheter and the clot

A Case Report Using Goose Neck Microsnare for Severe Cervical Internal Carotid Artery Occlusion with Dolichoarteriopathy

Mechanical thrombectomy utilising a collateral pathway in a patient with dysgenesis of the internal carotid artery

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