Impact of stent-retriever tip design on distal embolization during mechanical thrombectomy: a randomized in vitro evaluation

Li, Jiahui; Tiberi, Riccardo; Bhogal, Pervinder; Buhk, Jan‐Hendrik; Behme, Daniel; Ribó, Marc

doi:10.1136/jnis-2023-020382

Cited by 4 publications

(1 citation statement)

References 29 publications

(34 reference statements)

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“…Similarly, the closed nature of the distal end of the Stream device's braided net may also act as a distal clot catcher that prevents, at least to a degree, the loss of distal thrombi during the expansion of the device, as was recently demonstrated with another device [33]. Interestingly, in our study, distal emboli were only seen in 5.9% of cases despite having been reported in ≈25% of cases for devices with distal clot catchers [12].…”

Section: Discussionsupporting

confidence: 68%

The Stream Device—A Retrospective Review of 51 Cases

Kupcs,

Sproge,

Kupca

et al. 2023

JCM

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Mechanical thrombectomy is the gold-standard treatment for patients that have suffered large-vessel occlusion (LVO) stroke. Various different stent-retrievers, aspiration catheters, and techniques have been developed to perform this procedure. We present our initial results regarding the Stream device. Materials and Methods: We performed a retrospective review of a prospectively maintained database at our high-volume centre to identify all patients treated with the Stream device between February 2021 and January 2023. We recorded baseline demographics, NIHSS, ASPECT scores, eTICI scores, complications, and 90-day mRS. Results: We identified 51 patients, 49.0% of whom were male (n = 25), with a median age of 73 (range: 51–89) and a median NIHSS score of 17 (range 4–22), and 68.6% received IV tPA. The median ASPECT score was 10 (range 6–10). Hyperdense clots were seen in 34 cases (66.7%), with a mean clot length of 12 ± 6.2 mm (range 2–26 mm). Clots were located in the anterior circulation in 49 patients. The standard Stream device was used in 78.4% of cases, with Stream 17 being used in 19.6% of cases. The FPE was observed in 25.5% of cases (n = 13), with the mFPE being seen in 31.4% of cases (n = 16). A final eTICI score of ≥2b was achieved in 90.2% of cases (n = 46), and eTICI 2c/3 was seen in 84.3% of cases (n = 43). Furthermore, 24 h CT scans showed that the median ASPECT score was 8 (range 0–10). Good functional outcomes at 90 days (mRS ≤ 2) were achieved in 21.6% of cases (n = 11). Conclusions: The Stream device shows acceptable rates of FPE and mFPE compared to existing devices. Further larger studies are required alongside an understanding of the optimal technique for this device’s use.

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Section: Discussionsupporting

confidence: 68%

The Stream Device—A Retrospective Review of 51 Cases

Kupcs,

Sproge,

Kupca

et al. 2023

JCM

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Optimizing stent retrievers for mechanical enhancement and in vitro testing in acute ischemic stroke models

Lee,

Kim,

Kim

et al. 2024

BioMed Eng OnLine

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Background Acute ischemic stroke (AIS) remains a major cause of morbidity and mortality worldwide. Mechanical thrombectomy, especially with stent retrievers, offers a promising treatment, particularly for patients ineligible for intravenous tissue plasminogen activator (IV tPA) therapy. This study aimed to develop and evaluate novel stent retriever designs to enhance mechanical properties and vessel compatibility. Results We evaluated four stent designs using finite-element analysis (FEA) to assess their mechanical properties. Based on these evaluations, Stent D emerged as the optimal design due to its superior elasticity and adaptability. Comparative testing of Stent D against commercial stents, Solitaire FR and Trevo XP ProVue, revealed the following metrics: radial forces of 3.77 ± 0.01 N for Solitaire FR, 3.92 ± 0.08 N for Trevo XP ProVue, and 4.10 ± 0.07 N for Stent D; flexibility measurements of 0.38 ± 0.11 N for Solitaire FR, 0.91 ± 0.11 N for Trevo XP ProVue, and 0.59 ± 0.05 N for Stent D; deployment forces of 0.37 ± 0.02 N for Solitaire FR, 0.42 ± 0.04 N for Trevo XP ProVue, and 0.32 ± 0.02 N for Stent D; and recapture forces of 0.38 ± 0.01 N for Solitaire FR, 0.45 ± 0.02 N for Trevo XP ProVue, and 0.35 ± 0.01 N for Stent D. Thrombus retrieval rates were 96.16% for Solitaire FR and 95.51% for Stent D. Conclusions These findings demonstrate that Stent D performs comparably to commercial stents, highlighting its effective performance in AIS treatment. Stent D shows promise as a candidate for further clinical evaluation due to its superior mechanical properties and effective thrombus retrieval capabilities.

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Modeling Robotic-Assisted Mechanical Thrombectomy Procedures with the CorPath GRX Robot: The Core-Flow Study

Tomasello,

Hernández,

et al. 2024

AJNR Am J Neuroradiol

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Impact of stent-retriever tip design on distal embolization during mechanical thrombectomy: a randomized in vitro evaluation

Cited by 4 publications

References 29 publications

The Stream Device—A Retrospective Review of 51 Cases

The Stream Device—A Retrospective Review of 51 Cases

Optimizing stent retrievers for mechanical enhancement and in vitro testing in acute ischemic stroke models

Modeling Robotic-Assisted Mechanical Thrombectomy Procedures with the CorPath GRX Robot: The Core-Flow Study

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