Further Development of Combined Techniques Using Stent Retrievers, Aspiration Catheters and BGC

Maegerlein, Christian; Berndt, Maria; Mönch, Sebastian; Kreiser, Kornelia; Boeckh‐Behrens, Tobias; Lehm, Manuel; Wunderlich, Silke; Zimmer, Claus; Friedrich, Benjamin

doi:10.1007/s00062-018-0742-9

Cited by 62 publications

(51 citation statements)

References 26 publications

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“…The most successful strategy for removing the CCEs from the in vitro model was a combined technique, using a stent retriever with local aspiration under flow arrest conditions. This reflects previous studies, which report the success of a combined technique with a BGC in thrombus retrievals 30–32…”

Section: Discussionsupporting

confidence: 89%

Development of an in vitro model of calcified cerebral emboli in acute ischemic stroke for mechanical thrombectomy evaluation

Johnson

McCarthy

Fahy

et al. 2020

J NeuroIntervent Surg

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BackgroundCalcified cerebral emboli (CCEs) are a rare cause of acute ischemic stroke (AIS) and are frequently associated with poor outcomes. The presence of dense calcified material enables reliable identification of CCEs using non-contrast CT. However, recanalization rates with the available mechanical thrombectomy (MT) devices remain low.ObjectiveTo recreate a large vessel occlusion involving a CCE using an in vitro silicone model of the intracranial vessels and to demonstrate the feasability of this model to test different endovascular strategies to recanalize an occlusion of the M1 segment of the middle cerebral artery (MCA).MethodsAn in vitro model was developed to evaluate different endovascular treatment approaches using contemporary devices in the M1 segment of the MCA. The in vitro model consisted of a CCE analog placed in a silicone neurovascular model. Development of an appropriate CCE analog was based on characterization of human calcified tissues that represent likely sources of CCEs. Feasibility of the model was demonstrated in a small number of MT devices using four common procedural techniques.ResultsCCE analogs were developed with similar mechanical behavior to that of ex vivo calcified material. The in vitro model was evaluated with various MT techniques and devices to show feasibility of the model. In this limited evaluation, the most successful retrieval approach was performed with a stent retriever combined with local aspiration through a distal access catheter, and importantly, with flow arrest and dual aspiration using a balloon guide catheter.ConclusionCharacterization of calcified tissues, which are likely sources of CCEs, has shown that CCEs are considerably stiffer than thrombus. This highlights the need for a different in vitro AIS model for CCEs than those used for thromboemboli. Consequentially, an in vitro AIS model representative of a CCE occlusion in the M1 segment of the MCA has been developed.

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Section: Discussionsupporting

confidence: 89%

Development of an in vitro model of calcified cerebral emboli in acute ischemic stroke for mechanical thrombectomy evaluation

Johnson

McCarthy

Fahy

et al. 2020

J NeuroIntervent Surg

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“…The concept is to deploy the retriever and advance the aspiration catheter until it engages the clot. Relatively similar techniques have been described, mostly consisting of single-arm experiences10–13 and some comparative studies14–16 showing that it may be superior to either retriever or aspiration thrombectomy alone. The fundamental aim is to push the aspiration catheter slightly past the proximal end of the clot in order to ‘cork’ (partially ingest) the thrombus into the catheter.…”

Section: Discussionmentioning

confidence: 99%

Blind exchange with mini-pinning technique for distal occlusion thrombectomy

Haussen

Al‐Bayati

Eby

et al. 2019

J NeuroIntervent Surg

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IntroductionTechnical improvements to enhance distal occlusion thrombectomy are desirable. We describe the blind catheter exchange technique and report the pinning technique with small devices (‘mini-pinning’) for distal occlusions.MethodsA retrospective review of a prospective database from January 2015 to August 2018 was performed for cases of distal occlusion in which the ‘blind exchange/mini-pinning’ (BEMP) techniques were used. The technique involves the deployment of a 3 mm Trevo retriever followed by microcatheter removal and blind advancement of a 3MAX aspiration catheter over the bare retriever delivery wire (‘blind exchange’) until clot contact under aspiration. The retriever is subsequently partially recaptured in order to ‘cork’ the thrombus (‘mini-pinning’) and the system pulled as a unit. Patients with distal occlusions treated with BEMP and standard techniques (either 3 mm Trevo or 3MAX) were compared.ResultsTwenty-five vessels were treated in 22 patients. The majority of patients had isolated distal occlusions predominantly in the distal middle cerebral artery (MCA) segments, half of which involved the superior division. The comparison between BEMP (n=25 vessels) and standard techniques (n=144 vessels) revealed balanced groups. One of the highlighted differences was the more distal MCA occlusions among those who underwent BEMP (M3 occlusions 52% vs 22%; p=0.001). Otherwise, the vessel, segments, divisions and luminal diameter were comparable. There was a higher rate of first-pass modified Thrombolysis in Cerebral Infarction 2b–3 (80% vs 56%; p=0.03) and a trend towards higher rates of first-pass full reperfusion (60% vs 40%; p=0.07) with BEMP compared with standard techniques. Final reperfusion and clinical outcomes were comparable.ConclusionBEMP appears to be a safe and effective technique for the treatment of distal occlusions. Additional studies are warranted.

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“…-PROTECT: PRoximal balloon Occlusion TogEther with direCt Thrombus aspiration during stent retriever thrombectomy (n = 11) [23]: BGC + aspiration catheter + stent retriever (complete retrieval of the stent retriever into the aspiration catheter) -PROTECT PLUS (n = 18) [12]: BGC + aspiration catheter + stent retriever (only partial retrieval of the stent retriever into the aspiration catheter and withdrawal of both as a unit into the BGC).…”

Section: Angiographic Data and Differentiation Of Interventional Techmentioning

confidence: 99%

“…Especially the use of balloon guide catheters (BGC) has been established within the standard procedure in many neuro-interventional institutions by now, as it became evident that improved angiographic and clinical results can be achieved by using this technique [9][10][11][12][13]. This is undoubtedly affected by a reduction of distal (micro)emboli [14].…”

Section: Introductionmentioning

confidence: 99%

Endovascular stroke treatment using balloon guide catheters may reduce penumbral tissue damage and improve long-term outcome

et al. 2020

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Objectives During mechanical recanalization of large vessel occlusions (LVO), the use of proximal flow arrest with balloon guide catheters (BGC) was shown to be associated with better angiographic and even clinical outcome. The aim of the study was to analyze the impact of BGC use on microstructural alterations in the salvaged penumbra. Methods All patients who underwent mechanical recanalization of LVO of the anterior circulation were reviewed within a prospective stroke registry of a single comprehensive stroke center. Fifty-two patients received an admission CT perfusion together with post-interventional diffusion tensor imaging. Technical details such as BGC usage were correlated with microstructural integrity changes of the salvaged gray matter through the mean diffusivity (MD) index. Moderation analysis was performed to test the interaction of BGC on the correlation between angiographic and clinical outcomes. Results For all patients with complete reperfusion, microstructural integrity changes with lowered MD index were found within the salvaged penumbra for cases of non-BGC usage (mean − 0.02) compared to cases with BGC usage (0.01, p = 0.04). The importance of complete reperfusion for good clinical outcome is predominantly based on patients treated with BGC (effect 2.78, p = 0.01 vs. for non-BGC: 0.3, p = 0.71). Conclusions The lowered MD index early after mechanical recanalization without BGC usage can be interpreted as microstructural ischemic damage of the salvaged penumbra. It was shown that achieving complete reperfusion in a setting of BGC usage with proximal flow arrest minimizes penumbral damage and improves long-term outcomes. Key Points • Microstructural ischemic damage can be reduced by using proximal flow arrest during endovascular treatment with balloon guide catheter. • Complete reperfusion in a setting of balloon guide catheter minimizes penumbral damage and improves long-term outcome.

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Further Development of Combined Techniques Using Stent Retrievers, Aspiration Catheters and BGC

Cited by 62 publications

References 26 publications

Development of an in vitro model of calcified cerebral emboli in acute ischemic stroke for mechanical thrombectomy evaluation

Development of an in vitro model of calcified cerebral emboli in acute ischemic stroke for mechanical thrombectomy evaluation

Blind exchange with mini-pinning technique for distal occlusion thrombectomy

Endovascular stroke treatment using balloon guide catheters may reduce penumbral tissue damage and improve long-term outcome

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