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Li J, Tiberi R, Bhogal P, Buhk JH, Behme D, Tomasello A, Ribo M. Impact of stent-retriever tip design on distal embolization during mechanical thrombectomy: a randomized in vitro evaluation. J Neurointerv Surg 2024; 16:285-289. [PMID: 37147003 DOI: 10.1136/jnis-2023-020382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/25/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Repeated number of passes, clot fragmentation, and distal embolization during mechanical thrombectomy (MT) lead to worse clinical outcomes in acute ischemic stroke. This study aimed to assess the recanalization and embolic outcomes of different stent-retrievers (SRs): open-tip SR (Solitaire X 6×40 mm), closed-tip SR (EmboTrap II 5×33 mm), and filter-tip SR (NeVa NET 5.5×37 mm). METHODS Stiff-friable clot analogs were used to create middle cerebral artery (M1-MCA) occlusions in a benchtop model. After occlusion, experiments were randomized into one of the three treatment arms. The thrombectomy technique consisted of retrieving the SR into a balloon guide catheter under proximal flow arrest and continuous aspiration. A total of 150 single-attempt cases were performed (50 cases/treatment arm). Distal emboli (>100 µm) were collected and analyzed after each experiment. RESULTS Filter-tip SR achieved a non-significantly higher first-pass recanalization rate than open-tip SR and closed-tip SR (66% vs 48% vs 44%; P=0.064). Filter-tip SR prevented clot fragments>1 mm from embolizing distal territories in 44% of cases, compared with 16% in open-tip SR and 20% in closed-tip (P=0.003). There were no significant differences between treatment arms in terms of total emboli count (open-tip=19.2±13.1, closed-tip=19.1±10.7, filter-tip=17.2±13.0; P=0.660). Nonetheless, the number of large emboli (>1 mm) and total area of emboli were significantly lower in the filter-tip arm (n=0.88±1.2, A=2.06±1.85 mm2) than in the closed-tip arm (n=2.34±3.38, A=4.06±4.80 mm2; P<0.05). CONCLUSIONS When facing fragment-prone clots, the filter-tip SR significantly reduces the number of large clots (>1 mm) that embolize distally during an MT procedure, which in turn may increase the chances of first-pass complete recanalization.
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Affiliation(s)
- Jiahui Li
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Stroke Unit, Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Riccardo Tiberi
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Stroke Unit, Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Pervinder Bhogal
- Neuroradiology, The Royal London Hospital, Barts NHS Trust, London, UK
| | - Jan-Hendrik Buhk
- Neuroradiology, Asklepios Hospital Hamburg St Georg, Hamburg, Germany
| | - Daniel Behme
- Neuroradiology, University Medical Center Magdeburg, Magdeburg, Germany
| | - Alejandro Tomasello
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Interventional Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Marc Ribo
- Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
- Stroke Unit, Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
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Masthoff M, Krähling H, Akkurt BH, Elsharkawy M, Köhler M, Ergawy M, Thomas C, Schwindt W, Minnerup J, Stracke P. Evaluation of effectiveness and safety of the multizone NeVa TM stent retriever for mechanical thrombectomy in ischemic stroke. Neuroradiology 2023; 65:1777-1785. [PMID: 37878032 PMCID: PMC10654155 DOI: 10.1007/s00234-023-03236-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/04/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE This study aimed to evaluate the effectiveness and safety of the NeVaTM stent retriever as first- and second-line device for mechanical thrombectomy in acute ischemic stroke. METHODS In this retrospective single-center study, all consecutive patients that underwent mechanical thrombectomy with NeVaTM stent retriever as first- or second-line device due to intracranial vessel occlusion with acute ischemic stroke between March and November 2022 were included. RESULTS Thirty-nine patients (m=18, f=21) with a mean age of 69.9 ± 13.3 years were treated with the NeVaTM stent retriever. NeVaTM stent retriever was used as first-line device in 24 (61.5%) of patients and in 15 (38.5%) as second-line device. First-pass rate (≥mTICI 2c) of NeVaTM stent retriever was both 66.7% when used as first- or second-line device. Final recanalization rate including rescue strategies was 92.3% for ≥mTICI2c and 94.9% for ≥mTICI2b. No device-related minor or major adverse events were observed. A hemorrhage was detected in 33.3% of patients at 24h post-thrombectomy dual-energy CT, of which none was classified as symptomatic intracerebral hemorrhage. NIHSS and mRS improved significantly at discharge compared to admission (p<0.05). CONCLUSION The NeVaTM stent retriever has a high effectivity and good safety profile as first- and second-line device for mechanical thrombectomy in acute ischemic stroke.
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Affiliation(s)
- Max Masthoff
- Clinic for Radiology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Hermann Krähling
- Clinic for Radiology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Burak Han Akkurt
- Clinic for Radiology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Mohamed Elsharkawy
- Clinic for Radiology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
- Clinic for Radiology and Neuroradiology, Alfried Krupp Hospital, Essen, Germany
| | - Michael Köhler
- Clinic for Radiology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Mostafa Ergawy
- Clinic for Radiology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Christian Thomas
- Institute of Neuropathology, University of Muenster and University Hospital Muenster, Muenster, Germany
| | - Wolfram Schwindt
- Clinic for Radiology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Jens Minnerup
- Department of Neurology with Institute of Translational Neurology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Paul Stracke
- Clinic for Radiology, University of Muenster and University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
- Clinic and Policlinic for Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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3
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Liu R, He H, Zhang L, Fan Y, Wang J, Wang W. In vitro models for the experimental evaluation of mechanical thrombectomy devices in acute ischemic stroke. Interv Neuroradiol 2023; 29:759-767. [PMID: 35971288 PMCID: PMC10680957 DOI: 10.1177/15910199221118404] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
Mechanical thrombectomy has become an important method for the treatment of acute ischemic stroke for large vessel occlusions. The current hotspots of mechanical thrombectomy are optimizing the treatment methods, improving the recanalization rate and reducing complications. The in vitro model has become a common and convenient method for mechanical thrombectomy research. This review summarizes the in vitro model in the following aspects: the preparation of clot analogues; the experimental platform; the application of the in vitro model in the testing of thrombectomy devices; and the advantages, limitations and future trends of the in vitro experimental model. This review describes the characteristics and applications of the in vitro experimental model with the hope that the in vitro experimental model will be further improved and play a more effective role in the study of mechanical thrombectomy.
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Affiliation(s)
- Ronghui Liu
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beihang University, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China
| | - Hongping He
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China
| | - Luo Zhang
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China
| | - Yubo Fan
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beihang University, Beijing, China
| | - Jun Wang
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Weidong Wang
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China
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Bajrami A, Ertugrul O, Senadim S, Erdem E, Baltacioglu F, Geyik S. First pass results of mechanical thrombectomy with two-drop zone NeVa TM device. Interv Neuroradiol 2022:15910199221135309. [PMID: 36314456 DOI: 10.1177/15910199221135309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Occlusive thrombi in acute ischemic stroke can be in various types which limits the success of the thrombectomy. The NeVaTM (Vesalio, Nashville, Tennessee) thrombectomy device was originally designed for all types of clot. Our aim was to evaluate the efficacy and safety of the NeVaTM device for mechanical thrombectomy. METHODS Retrospective review of prospectively collected mechanical thrombectomy database revealed 145 patients who had fullfilled the inclusion criteria. The data collected includes clinical patient characteristics, procedural measures, timestamp at each stage, and patient outcome. IV thrombolytics application, pre and post-intervention imaging findings, device related adverse event and any type of intracranial hemorrhage were recorded. RESULTS There was female pre-dominance (54.5%). Median presenting national institutes of health stroke scale (NIHSS) was 16 (IQR, 3-32). 88 MCA-m1 (60,6%), 43 ICA-tip (29,6%), 11 MCA-m2 (7,5%), 2 ACA (1,4%) and 1 basilar (0,7%) occlusions were underwent for mechanical thrombectomy. Median procedure time was 25 min (IQR, 7-136). First-pass reperfusion scores were mTICI 0-2a 22.7%, mTICI 2b 23.4%, mTICI 2c 17.9% and mTICI 3 35.9%. Mean number of pass was 1,84 ± 1,14. Final mTICI 2b-3 score was 97.9% and TICI2c-3 score was 87.6%. No device related adverse event occurred. The mean 24-h NIHSS score was 6 (IQR 0-33). CONCLUSION In conclusion, the NeVa thrombectomy device offers a high rate of first-pass success along with favorable safety profile. Larger series and multi-center studies are needed for further investigation.
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Affiliation(s)
- Arsida Bajrami
- Department of Neurology, Istanbul Aydın University, IAU Stroke Center, Istanbul, Turkey
| | - Ozgur Ertugrul
- Department of Radiology, Istanbul Aydın University, IAU Stroke Center, Istanbul, Turkey
| | - Songul Senadim
- Department of Neurology, Istanbul Aydın University, IAU Stroke Center, Istanbul, Turkey
| | - Eren Erdem
- Department of Radiology, Istanbul Aydın University, IAU Stroke Center, Istanbul, Turkey
| | | | - Serdar Geyik
- Department of Radiology, Istanbul Aydın University, IAU Stroke Center, Istanbul, Turkey
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Liu R, Jin C, Wang L, Yang Y, Fan Y, Wang W. Simulation of stent retriever thrombectomy in acute ischemic stroke by finite element analysis. Comput Methods Biomech Biomed Engin 2021; 25:740-749. [PMID: 34792427 DOI: 10.1080/10255842.2021.1976761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Stent retriever thrombectomy has become an effective method for treating acute ischemic stroke. Successful recanalization cannot be achieved for all patients. The outcome of mechanical thrombectomy may be associated with some mechanical factors, requiring efficient tools that are able to assess the interaction between stent retrievers and clots. In this study, a simulation by finite element analysis was developed to evaluate the outcome of stent retriever thrombectomy for clots of different sizes and frictional properties. The deployment and retrieval of the stent retriever were conducted in a middle cerebral artery model. The recanalization, deformation of the clot and stent retriever and the stress induced in the clot were assessed. The results showed that higher friction could lead to failed recanalization and increased stress in the clot. The simulation method can be used to characterize the mechanical behaviour of stent retrievers and clots, offering a potential tool for the optimization of device design and the selection of surgical strategies.
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Affiliation(s)
- Ronghui Liu
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China
| | - Chang Jin
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China
| | - Lizhen Wang
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yisong Yang
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China
| | - Yubo Fan
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Weidong Wang
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China
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He G, Deng J, Zhang Y, Lu H, Zhao Y, Yan L, Zhu Y. Mechanical thrombectomy injury to the arterial wall: A comparison between catheter aspiration and stent retriever. Eur J Radiol 2021; 139:109723. [PMID: 33905977 DOI: 10.1016/j.ejrad.2021.109723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare the extent of arterial wall damage when SR and CA were used for treatment of AIS models to evaluate their efficacy and safety. METHODS A thrombin-induced thrombus was pre-injected into the right distal external carotid-maxillary artery (ECMA) in 12 dogs to create an acute thrombus occlusion model and were randomly divided into the SR group (n = 6; received SR treatment) and CA group (n = 6; received CA treatment). Device safety was also assessed by five passages through the normal left ECMA using each device. Device manipulation-related damage to arterial walls, final flow restoration, recanalization time and complications were recorded. RESULTS Sixteen retriever and 10 aspiration attempts were performed in the SR and CA groups. Reperfusion time was significantly reduced in the CA group (17.83 ± 1.96 vs. 28.33 ± 3.26 in the SR group; P = 0.02). Stent retriever thrombectomy resulted in an increased risk of endothelium denudation (1.17 ± 0.24 in SR group vs. 0.42 ± 0.15 in CA group; P = 0.01) and reduced frequency of vessel vasospasm (0.67 ± 0.14 in SR group vs. 0.25 ± 0.13 in CA group; P = 0.04). Injury score and thrombus deposition were similar between the two groups (P > 0.05). TICI 2b/3 flow restoration values of the right ECMA were 100 % in both groups. Device-related complications, including dissection (P = 0.21), side branch influence (P = 0.24), and distal thromboembolism (P = 1.00), did not differ between the two groups. CONCLUSION Both devices had similar efficacy and caused minimal arterial wall damage in our dog models. SR was more likely to cause endothelium denudation, while CA had a greater risk of vasospasm.
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Affiliation(s)
- Guangchen He
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, China
| | - Jiangshan Deng
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, China
| | - Yiran Zhang
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, China
| | - Haitao Lu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, China
| | - Yuwu Zhao
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, China
| | - Lei Yan
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou, 450052, China.
| | - Yueqi Zhu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai, 200233, China.
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Akpinar CK, Ozdemir AO, Gurkas E, Bilgic AB, Aykac O, Inanc Y, Giray S. Favorable first-pass recanalization rates with NeVa™ thrombectomy device in acute stroke patients: Initial clinical experience. Interv Neuroradiol 2021; 27:107-113. [PMID: 32615827 PMCID: PMC7903549 DOI: 10.1177/1591019920938223] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/08/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The NeVa™ thrombectomy device (Vesalio LLC, Nashville, USA) has been reported to succeed in large vessel occlusion thrombectomy in animal, in-vitro, and clinical studies. Designed with Drop Zone technology, a closed distal tip, and strong expansive radial force, the device demonstrated particular efficiency in resistant "white" thrombi in preclinical research. Our goal is to determine the safety and performance of this novel stent retriever on first-pass rates and overall recanalization. METHODS The Interventional Neurology Database is a prospectively maintained database of anterior and posterior circulation stroke thrombectomy cases. We retrospectively analyzed cases where the NeVa™ thrombectomy device was used as the first-line treatment strategy. Data collection occurred between January 2019 and January 2020. First-pass recanalization, final recanalization, 90-day functional outcome, complication, and bleeding rates are reported. RESULTS One hundred eighteen patients were treated with the NeVa™ thrombectomy device. The mean patient age was 69 ± 14 years, the median baseline National Institutes of Health Stroke Scale was 14, and the median initial Alberta Stroke Program Early Computed Tomography score was 8. The median time from groin puncture to successful recanalization was 29 min (interquartile range (IQR): 20-40). First-pass recanalization rates were 56.8% (modified treatment in cerebral infarction (mTICI) 2b/3) and 44.9% (mTICI 2c/3). Final successful recanalization rate was 95.8% (thrombolysis in cerebral infarction 2b/3). Favorable functional outcome (modified Rankin Scale 0-2) was 53% in the "first-pass" subgroup and 42.4% in the total patient population. The median number of passes to achieve the final recanalization score was 1 (IQR 1-2). The rate of embolization into new territory was 1.7%. Four patients (3.3%) had symptomatic hemorrhage. CONCLUSIONS In our experience, the NeVa™ device demonstrated high first-pass and overall recanalization rates along with a good safety profile.
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Affiliation(s)
- Cetin K Akpinar
- Interventional Neurology, Neurology
Clinic, Sağlık Bilimleri University, Samsun Training and Research Hospital,
Samsun, Turkey
| | - Atilla O Ozdemir
- Department of Neurology,
Neurocritical Care, Cerebrovascular Disease, Interventional Neurology, Eskisehir
Osmangazi University, Eskisehir, Turkey
| | - Erdem Gurkas
- Interventional Neurology, Neurology
Clinic, Sağlık Bilimleri University, Lütfi Kırdal Training and Research
Hospital, İstanbul, Turkey
| | - Adnan B Bilgic
- Interventional Neurology, Neurology
Clinic, Sağlık Bilimleri University, Samsun Training and Research Hospital,
Samsun, Turkey
| | - Ozlem Aykac
- Department of Neurology,
Neurocritical Care, Cerebrovascular Disease, Interventional Neurology, Eskisehir
Osmangazi University, Eskisehir, Turkey
| | - Yusuf Inanc
- Department of Neurology,
Neurocritical Care, Cerebrovascular Disease, Interventional Neurology, Gaziantep
University, Gaziantep, Turkey
| | - Semih Giray
- Department of Neurology,
Neurocritical Care, Cerebrovascular Disease, Interventional Neurology, Gaziantep
University, Gaziantep, Turkey
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Bernava G, Rosi A, Boto J, Brina O, Kulcsar Z, Czarnetzki C, Carrera E, Schaller K, Lovblad KO, Machi P. Direct thromboaspiration efficacy for mechanical thrombectomy is related to the angle of interaction between the aspiration catheter and the clot. J Neurointerv Surg 2019; 12:396-400. [PMID: 31548213 PMCID: PMC7146918 DOI: 10.1136/neurintsurg-2019-015113] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022]
Abstract
Background Direct thromboaspiration has been reported as an effective mechanical treatment for acute ischemic stroke. We aimed to determine whether the angle of interaction between the aspiration catheter and the clot affects the success of clot removal in ischemic stroke patients with large vessel occlusion in the anterior and posterior circulation. Methods All patients treated at our institution by direct thromboaspiration as a firstline technique between January 2016 and December 2017 were enrolled in the study. We retrospectively reviewed baseline and procedural characteristics, the angle of interaction formed between the aspiration catheter and the clot, the modified Thrombolysis in Cerebral Infarction score, and the 3 month modified Rankin Scale score. Results 85 patients underwent direct thromboaspiration as the firstline treatment during the study period. 100 direct thromboaspiration passes were performed. An angle of interaction of ≥125.5° significantly influenced the success of clot removal (P<0.001) with good sensitivity and specificity, in particular for occlusion of the middle cerebral and basilar artery. The combination of aspiration with a stent retriever based thrombectomy was a valid rescue treatment in cases of standalone direct thromboaspiration failure. Conclusions In our series, an angle of interaction between the aspiration catheter and the clot of ≥125.5° was significantly associated with successful clot removal. The prediction of the angle of interaction on pretreatment imaging may help operators to select the most adequate mechanical thrombectomy technique on a case by case basis.
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Affiliation(s)
| | - Andrea Rosi
- Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland
| | - José Boto
- Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Olivier Brina
- Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Zsolt Kulcsar
- Neuroradiology, University Hospitals of Zurich, Zurich, Switzerland
| | | | | | - Karl Schaller
- Neurosurgery, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Paolo Machi
- Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland
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