Comparison of Modern Stroke Thrombectomy Approaches Using an In Vitro Cerebrovascular Occlusion Model

Abstract

BACKGROUND AND PURPOSE:A new in vitro cerebrovascular occlusion model of the intracranial circulation was developed recently for testing thrombectomy devices. Using this model, we compared recanalization success associated with different modern endovascular thrombectomy approaches.

Initial clinical experience using the two-stage aspiration technique (TSAT) with proximal flow arrest by a balloon guiding catheter for acute ischemic stroke of the anterior circulation

“…In an in vitro study the rate of EDT reached 13%, which is similar to the rates reported in the ADAPT and ADAPT FAST studies 20. In the in vitro study, although clot removal via ADAPT tended to be more efficient for reducing large fragments (200–1000 μm), ADAPT led to high numbers of distal emboli in the size ranges of 100–200, 50–100, and <50 μm 15…”

“…An in vitro vascular model has also shown that a stent retriever and traditional aspiration thrombectomy result in fragmentation of the embolus during extraction, creating downstream emboli and, potentially, emboli to previously uninvolved vascular territories 15 19 20…”

Effects of Difference in the Guiding System on the Results of Thrombectomy

“…There have been reports of a few in vitro studies concerning which delivery system provides the highest recanalization rate with the lowest incidence of ENT/EDT. 3,4) In this study, we reviewed past cases treated at our institution and compared the therapeutic results between groups treated with BGC alone and in combination with DAC. The time from puncture to recanalization was significantly shorter in the BGC + DAC group (p = 0.03).…”

Novel and emerging technologies for endovascular thrombectomy

“…23 Balloon guide catheters can be used to halt anterograde blood flow in the affected vascular territory and serve to reduce distal embolization during thrombectomy attempts, although their utility is currently debated. 12,35,37,47,52 In addition, BGCs have been reported as a primary means for aspiration thrombectomy in proximal occlusions. 17 Currently, the Penumbra aspiration catheters (Penumbra, Inc.) are the only catheters approved by the FDA for aspiration thrombectomy, and their use has resulted in TICI Grade 2b/3 in 57%-84% of cases.…”