Exploring the efficacy of cyclic vs static aspiration in a cerebral thrombectomy model: an initial proof of concept study

Simon, Scott D.; Grey, Clare P.; Massenzo, Trisha J.; Simpson, David G.; Longest, P. Worth

doi:10.1136/neurintsurg-2013-010941

Cited by 31 publications

(31 citation statements)

References 23 publications

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“…In addition to the aspiration force, the use of cyclical aspiration instead of continuous aspiration could result in higher first-pass recanalization rates and lower distal clot embolization. 31 32 One hypothesis is that cyclical aspiration allows larger clot ingestion into the aspiration catheter and causes less clot fragmentation than continuous aspiration. 31 Although DA could be used with either a long introducer sheath or a BGC, recent retrospective studies have shown that utilization of a BGC might improve the final and first-pass recanalization rates.…”

Section: Factors Influencing the Success Of Direct Aspiration Technicmentioning

confidence: 99%

Direct aspiration stroke thrombectomy: a comprehensive review

Boisseau

Escalard

Fahed³

et al. 2020

J NeuroIntervent Surg

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Mechanical thrombectomy is now the standard of care for acute ischemic stroke patients with large vessel occlusions, and can be performed with several devices and techniques. One of these techniques, direct aspiration (DA), consists of navigating a large-bore catheter up to the face of the clot and initiating forceful suction. This comprehensive review has three objectives: (1) to describe the direct aspiration technique; (2) to present the available evidence regarding predictive factors of DA success and performance compared with other techniques; and (3) to discuss the forthcoming improvements in distal aspiration.

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Section: Factors Influencing the Success Of Direct Aspiration Technicmentioning

confidence: 99%

Direct aspiration stroke thrombectomy: a comprehensive review

Boisseau

Escalard

Fahed³

et al. 2020

J NeuroIntervent Surg

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“…Our results showed that overall labeled-ID correlated with the achieved experimental asp-F, however, we observed that larger catheters did not necessarily lead to the highest asp-F, or catheters with identical labeled-ID showed up to 13.05 % variability in their experimental asp-F. Our findings, in line with previous publications [10], confirm that labeled-ID is not the only factor determining the experimental asp-F of a device and therefore, additional variables should be considered. Long et al [16] presented a novel catheter design and demonstrated that a larger proximal ID could [17] also increase the eff-ID of the catheter and consequently, the asp-F. Boisseau et al [12] re-ported in their review that, besides catheter labeled-ID, other factors like the use of cyclical aspiration [18], [19] or balloon guide catheter [17], the contact angle between clot and catheter [20] and the clot composition [21] may influence the success of aspiration.…”

Section: Discussionmentioning

confidence: 99%

Catheter tip distensibility substantially influences the aspiration force of thrombectomy devices

Castaño

Lascuevas

et al. 2021

J NeuroIntervent Surg

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BackgroundA direct aspiration first pass thrombectomy (ADAPT) is a fast-growing technique for which a broad catalog of catheters that provide a wide range of aspiration forces can be used. We aimed to characterize different catheters' aspiration performance on stiff clots in an in vitro vascular model. We hypothesized that labeled catheter inner diameter (labeled-ID) is not the only parameter that affects the aspiration force (asp-F) and that thrombus–catheter tip interaction and distensibility also play a major role.MethodsWe designed an experimental setup consisting of a 3D-printed carotid artery immersed in a water deposit. We measured asp-F and distensibility of catheter tips when performing ADAPT on a stiff clot analog larger than catheter labeled-ID. Correlations between asp-F, catheter ID, and tip distensibility were statistically assessed.ResultsExperimental asp-F and catheter labeled-ID were correlated (r=0.9601; P<0.01). The relative difference between experimental and theoretical asp-F (obtained by the product of the tip’s section area by the vacuum pressure) correlated with tip’s distensibility (r=0.9050; P<0.01), evidencing that ADAPT performance is highly influenced by catheter tip shape-adaptability to the clot and that the effective ID (eff-ID) may differ from the labeled-ID specified by manufacturers. Eff-ID showed the highest correlation with experimental asp-F (r=0.9944; P<0.01), confirming that eff-ID rather than labeled-ID should be considered to better estimate the device efficiency.ConclusionsCatheter tip distensibility can induce a significant impact on ADAPT performance when retrieving a stiff clot larger than the device ID. Our findings might contribute to optimizing thrombectomy strategies and the design of novel aspiration catheters.

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“…In a study on cyclical aspiration, a SOFIA Plus catheter (MicroVention Inc., Aliso Viejo, CA) had static (29 inHg) or cyclical (18–29 inHg, 0.5 Hz) aspiration employed using the digital CLEAR Aspiration System (Insera Therapeutics, Sacramento, CA) and eight thrombus aspiration experiments were conducted for each aspiration type in a flow model. The study showed that by varying the pressure dynamics through cyclical aspiration, it increased aspiration force on the occlusion as well as resulted in more successful clot clearance when compared with static aspiration ( 48 ). The cause of this improved ingestion may be due to the initial clot softening from dynamic compression or that dynamic friction is less than the static friction that occurs when the thrombus is stuck at the tip of the catheter.…”

Section: Devicesmentioning

confidence: 99%

Evidence-Based Updates to Thrombectomy: Targets, New Techniques, and Devices

et al. 2021

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Endovascular thrombectomy (EVT) has been validated in several randomized controlled trials in recent years for its efficacy in the treatment of acute ischemic strokes (AIS) and is now the standard of care according to international guidelines. However, in about 20% of EVT procedures, recanalization is not achieved, and over 50% of patients who undergo EVT still do not have good functional outcome. In this article, we provide an extensive review of the latest evidence and developments in the field of EVT, with particular focus on the factors that improve patient outcomes. These factors include new and adjunctive techniques such as combination of direct aspiration and stent retriever, intra-arterial urokinase or 2b/3a inhibitors, rescue stenting, as well as novel devices including balloon guide catheters and the newer generations of aspiration catheters and stent retrievers. We also examined the latest notion of using first-pass effect (FPE) as the target to achieve during EVT, which has been associated with an improved functional outcome. While the field of EVT has been rapidly evolving, further research is required in specific AIS patient populations such as those with large ischemic core, late presentation beyond 24 h, posterior circulation strokes, and with distal medium vessel occlusion or tandem lesions to better assess its efficacy and safety.

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Exploring the efficacy of cyclic vs static aspiration in a cerebral thrombectomy model: an initial proof of concept study

Cited by 31 publications

References 23 publications

Direct aspiration stroke thrombectomy: a comprehensive review

Direct aspiration stroke thrombectomy: a comprehensive review

Catheter tip distensibility substantially influences the aspiration force of thrombectomy devices

Evidence-Based Updates to Thrombectomy: Targets, New Techniques, and Devices

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