Histopathologic Evaluation of Arterial Wall Response to 5 Neurovascular Mechanical Thrombectomy Devices in a Swine Model

Abstract

BACKGROUND AND PURPOSE:Five commercial devices are available for mechanical thrombectomy in acute ischemic stroke. This study evaluated and compared the resultant arterial damage from these devices.

Double Solitaire Mechanical Thrombectomy in Acute Stroke: Effective Rescue Strategy for Refractory Artery Occlusions?

“…These included 5 patients treated for MCA M1 occlusion; 3, for ICAT occlusion; and 2, for ICA tandem occlusion, which overall represented 4.3% of all patients undergoing anterior circulation MT procedures during the analyzed time (see above). The median baseline NIHSS score was 16 (interquartile range, [13][14][15][16][17][18][19], and the median time from symptom onset to the start of the MT procedure was 168 minutes (interquartile range, 150 -179 minutes). For both ICA tandem occlusions, proximal ICA stent placement was performed before MT.…”

“…Cervical or intracranial vessel trauma remains a potentially serious procedure-related adverse event, which occurs at a low incidence with the use of the standard single SR MT technique. 3,5,10,15,16 In the Solitaire FR With the Intention For Thrombectomy trial, the reported incidences of arterial dissection, symptomatic cerebral hemorrhage, and SAH were 4.5%, 1.1%, and 1.1%, respectively. 15 The use of 2 parallel SRs within the MCA or ICA vessel lumen may potentially increase the force on the endothelium during the retrieval maneuver.…”

One-Year MR Angiographic and Clinical Follow-Up after Intracranial Mechanical Thrombectomy Using a Stent Retriever Device

“…These delayed arterial abnormalities are of unknown pathophysiologic etiology but may illustrate device-related arterial wall damage, which, up to now, was mainly reported in histopathologic animal studies. 18,6 Pre-existing stenosis did not appear to have worsened at 1-year FU or to be likely after MET. All arterial abnormalities remained asymptomatic during the FU period, and no independent predictor of arterial abnormality was identified.…”

“…6 The only published short-term angiographic follow-up study after MET by using various devices reported 0.9% arterial occlusion and 3.4% de novo stenosis. All cases were asymptomatic and identified as a consequence of arterial wall damage likely due to MET.…”

“…In animal models, MET was shown to be responsible for vascular damage, 6,7 depending on the device type, proving less frequent with wall-contact devices such as stent retrievers than with aspiration ones. 6 The only published short-term angiographic follow-up study after MET by using various devices reported 0.9% arterial occlusion and 3.4% de novo stenosis.…”