Experimental Evaluation of Direct Thromboaspiration Efficacy According to the Angle of Interaction Between the Aspiration Catheter and the Clot

Overview

Journal J Neurointerv Surg

Publisher BMJ Publishing Group

Specialty Neurology

Date 2021 Jan 23

PMID 33483456

Citations 6

Authors

Gianmarco Bernava

Andrea Rosi

Jose Boto

Jeremy Hofmeister

Olivier Brina

Philippe Reymond

Michel Muster

Hasan Yilmaz

Zsolt Kulcsar

Emmanuel Carrera

Mohamed Bouri

Karl-Olof Lovblad

Paolo Machi

Affiliations

Soon will be listed here.

Abstract

Background: Successful direct thromboaspiration (DTA) is related to several factors such as clot consistency, size, and location. It has also been demonstrated recently that the angle of interaction (AOI) formed by the aspiration catheter and the clot is related to DTA efficacy. The aims of this study were three-fold: (a) to confirm the clinical finding that the AOI formed by the aspiration catheter and the clot influence DTA efficacy; (b) to evaluate to what extent this influence varies according to differences in clot consistency and size; and (c) to validate stent retriever thrombectomy as an effective rescue treatment after DTA failure in the presence of an unfavorable AOI.

Methods: A rigid vascular phantom designed to reproduce a middle cerebral artery trifurcation anatomy with three M2 segments forming different angles with M1 and thrombus analog of different consistencies and sizes was used.

Results: DTA was highly effective for AOIs >125.5°, irrespective of thrombus analog features. However, its efficacy decreased for acute AOIs. Rescue stent retriever thrombectomy was effective in 92.6% of cases of DTA failure.

Conclusions: This in vitro study confirmed that the AOI formed by the aspiration catheter and the thrombus analog influenced DTA efficacy, with an AOI >125.5° related to an effective DTA. Stent retriever thrombectomy was an effective rescue treatment after DTA failure, even in the presence of an unfavorable AOI.

Citing Articles

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Experimental comparison of first-pass effect between direct thromboaspiration and combined thrombectomy in the setting of distal basilar occlusion.

Seiffert R, Brina O, Reymond P, Hofmeister J, Bernava G, Rosi A Interv Neuroradiol. 2024; :15910199241254412.

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"The microcatheter contrast injection technique": A novel technique to detect the proximal end of a thrombus in mechanical thrombectomy.

Iida Y, Mori K, Kawahara Y, Fukui I, Yamashita R, Takeda M Neuroradiol J. 2023; 38(1):98-105.

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Kim J, Kim B, Kim D AJNR Am J Neuroradiol. 2022; 43(10):1431-1436.

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evaluation of how the presence of the stent retriever and microcatheter influences aspiration parameters in thrombectomy according to their position inside the aspiration catheter.

Bernava G, Brina O, Reymond P, Rosi A, Hofmeister J, Yilmaz H Interv Neuroradiol. 2022; 30(4):489-495.

PMID: 36348632 PMC: 11528783. DOI: 10.1177/15910199221135040.

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