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. 2021 Dec;13(12):1152-1156.
doi: 10.1136/neurintsurg-2020-016889. Epub 2021 Jan 22.

Experimental evaluation of direct thromboaspiration efficacy according to the angle of interaction between the aspiration catheter and the clot

Gianmarco Bernava  1 , Andrea Rosi  2 , José Boto  2 , Jeremy Hofmeister  2 , Olivier Brina  2 , Philippe Reymond  2 , Michel Muster  2 , Hasan Yilmaz  2 , Zsolt Kulcsar  3 , Emmanuel Carrera  4 , Mohamed Bouri  5 , Karl-Olof Lovblad  2 , Paolo Machi  2
Affiliations

Experimental evaluation of direct thromboaspiration efficacy according to the angle of interaction between the aspiration catheter and the clot

Gianmarco Bernava et al. J Neurointerv Surg. 2021 Dec.

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.

Keywords: device; stent; stroke; thrombectomy.

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Conflict of interest statement

Competing interests: PM is consultant for Medtronic and Stryker.

Figures

Figure 1
Figure 1
(A) Schematic representation of the vascular phantom used for the experiments, with vessel diameters and angles between M1 and M2 branches. (B) Thrombus analog location and catheter positioning for M1 occlusion experiments. (C) Location of thrombus analogs and catheter positioning for M1-M2 occlusion experiments. (D) Location of thrombus analogs and catheter positioning for M2 occlusion experiments.
See this image and copyright information in PMC

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