Under Pressure: Comparison of Aspiration Techniques for Endovascular Mechanical Thrombectomy

Nikoubashman, Omid; Wischer, D.; Hennemann, H; Büsen, Martin; Brockmann, Carolin; Wiesmann, Martin

doi:10.3174/ajnr.a5605

Cited by 22 publications

(20 citation statements)

References 14 publications

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“…The authors suggest that this may be due to an optimised ratio between the size of the vessel and the aspiration catheter that leads to better ingestion of the clot. Whilst this seems plausible and is in line with in vitro studies published by Nikoubashman et al [14,15], this issue is reduced with the use of stent retrievers since they, by design, adapt to the vessel diameter and therefore minimise issues of size. A sub-group analysis of the ASTER trial data comparing the results of patients with M1 clots would help to shed light on whether there is an optimal strategy based on clot location especially given that the majority of patients in this trial had clots that were located in the M1 segment.…”

Section: Predictors Of Success With Aspirationsupporting

confidence: 58%

The Aspirations of Direct Aspiration for Thrombectomy in Ischemic Stroke: A Critical Analysis

et al. 2019

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The treatment of acute ischemic stroke by mechanical thrombectomy has been revolutionary, however most of the clinical trials were done with the use a stent retriever. At the same time, an alternative technique of thrombectomy through direct aspiration with a large bore distal access catheter at the face of the clot is rapidly gaining popularity. Nonetheless, the data supporting this new technique is not yet as mature as that available on stent retrievers. This review is a critical analysis of the evidence supporting the principle of direct aspiration thrombectomy and a discussion of its potential strengths and weaknesses in comparison to the available studies on stent retrievers. While this is by no means a conclusive review, it should serve as a yardstick of where the science is currently, and what are the next trials that are necessary.

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Section: Predictors Of Success With Aspirationsupporting

confidence: 58%

The Aspirations of Direct Aspiration for Thrombectomy in Ischemic Stroke: A Critical Analysis

et al. 2019

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“…The 8F sheath resulted in an average reduction of vessel diameter and cross-sectional area of 61% and 37%, respectively, and the sheath did not significantly reduce blood flow (236 Ϯ 25 mL/min, P ϭ . 19). Pump aspiration resulted in a significant flow reduction with a net flow of 225 Ϯ 25 mL/min (P Ͻ .001) (Fig 2).…”

Section: Resultsmentioning

confidence: 99%

“…In an average patient and without application of a balloon-guide catheter, which restricts antegrade flow, the amount of aspirated blood in the ICA should surpass its normal flow of 240 mL/min to achieve reliable flow reversal. 19 There is an ongoing discussion of whether BGCs or large-bore sheaths are needed for effective flow management. Large-bore sheaths allow aspiration of high-flow volumes up to approximately 1000 mL/ min.…”

Section: Discussionmentioning

confidence: 99%

Balloon-Guide Catheters Are Needed for Effective Flow Reversal during Mechanical Thrombectomy

Nikoubashman¹,

Wischer²,

Hennemann³

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Blood flow management in the carotid artery during mechanical thrombectomy is crucial for safety and effectiveness. There is an ongoing discussion about whether balloon-guide catheters or large-bore sheaths are needed for effective flow management. We compared general flow characteristics of proximal aspiration through a large-bore sheath and a balloon-guide catheter in a porcine in vivo model. MATERIALS AND METHODS: We investigated blood flow in a porcine common carotid artery with and without aspiration (VacLok syringe and Penumbra pump, Pump MAX) through an 8F-long sheath and an 8F balloon-guide catheter. Blood hemodynamics were assessed via continuous duplex sonography. RESULTS: Average vessel diameter and baseline blood flow were 4.4 Ϯ 0.2 mm and 244 Ϯ 20 mL/min, respectively. For the 8F sheath, pump aspiration resulted in a significant flow reduction (225 Ϯ 25 mL/min, P Ͻ .001), but with a persisting antegrade stream. Manual aspiration resulted in collapse of the vessel in 2 of 7 measurements and oscillatory flow with antegrade systolic and retrograde diastolic components in the remaining 5 measurements. Net flow was antegrade (52 Ϯ 44 mL/min) in 3 and retrograde (Ϫ95 Ϯ 52 mL/min) in the remaining 2 measurements. For balloon-guide catheters, balloon inflation always resulted in flow arrest. Additional pump or manual aspiration resulted in significant flow reversal of Ϫ1100 Ϯ 230 and Ϫ468 Ϯ 46 mL/min, respectively (both, P Ͻ .001). CONCLUSIONS: Only balloon-guide catheters allow reliable blood flow arrest and flow reversal in combination with aspiration via syringes or high-flow pump systems. Aspiration through an 8F sheath results in either collapse of the vessel or oscillatory flow, which can result in a net antegrade or retrograde stream.

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“…Other investigators have assessed the technical characteristics of various catheters and aspiration techniques in generating optimal suction forces. Nikoubashman et al observed consistently high suction flow rates with both a 60 cc vacuum syringe and the Medela Flex pump, compared with the Penumbra Max aspiration system 9. This result held true for a variety of catheter types, from an 8-French long sheath (Shuttle Select, Cook, Illinois, USA) to a smaller Catalyst six distal access catheter (Stryker, Michigan, USA).…”

Section: Discussionmentioning

confidence: 96%

A technical comparison of thrombectomy vacuum aspiration systems

Yaeger

Iserson

Singh

et al. 2019

J NeuroIntervent Surg

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IntroductionImproved functional outcomes after mechanical thrombectomy for emergent large vessel occlusion depend on expedient reperfusion after clinical presentation. Device technology has improved substantially over the years, and several commercial options exist for both large-bore aspiration catheters and suction pump systems.ObjectiveTo compare various vacuum pumps and examine the aspiration forces they generate as well as the force of catheter tip detachment from an artificial thrombus.MethodsUsing an artificial thrombus made from polyvinyl alcohol gel, we tested various mechanical characteristics of commercially available suction pumps, including the Penumbra Jet Engine, Penumbra Max, Stryker Medela AXS, Microvention Gomco, and a 60 cc syringe. Both aspiration pressure and tip force generated were analyzed. Subsequently, a cohort of thrombectomy catheters were assessed using the Penumbra Jet Engine to determine tip forces generated on an artificial thrombus. One-way analysis of variance was used to assess statistical significance.ResultsThe Penumbra Jet Engine system generated both the highest maximum aspiration pressures (28.8 inches Hg) and the highest tip force (23.68 grams force (gf)) on an artificial thrombus, with statistical significance compared with the other pump systems. Using the Jet Engine, the largest-bore catheter was associated with the highest tip force (32.12 gf). The overall correlation coefficient between catheter inner diameter and tip force was 0.98.ConclusionsThe Penumbra Jet Engine pump generates significantly higher vacuum pressures and tip forces than the other commercially available aspiration pump systems. Furthermore, catheters with a larger inner diameter generate higher tip suction forces on aspiration. Whether these mechanical features lead to improved clinical outcomes is yet to be determined.

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Under Pressure: Comparison of Aspiration Techniques for Endovascular Mechanical Thrombectomy

Cited by 22 publications

References 14 publications

The Aspirations of Direct Aspiration for Thrombectomy in Ischemic Stroke: A Critical Analysis

The Aspirations of Direct Aspiration for Thrombectomy in Ischemic Stroke: A Critical Analysis

Balloon-Guide Catheters Are Needed for Effective Flow Reversal during Mechanical Thrombectomy

A technical comparison of thrombectomy vacuum aspiration systems

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