Experimental Evaluation of Stent Clot Retrieval Using the Confront Clot Scrambling Method with an Equitable Automatic Withdrawal Machine

A Method to Evaluate Vessel Deviation during Withdrawal of a Stent Retriever Using a Silicon Vascular Model

Objective

Catastrophic complications may develop because of vessel deviation during device delivery into intracranial vessels for neurointerventions. We report a novel method using a silicon model capable of evaluating vessel deviation as a numerical value.

Methods

In all, 10 tiny markers, each with a pitch of approximately 5 mm, were attached to the vessel model along the long axis. We used a high-resolution camera to record movies of the deviation of the vessel model while employing different stent retrievers. The movies were reviewed to determine the maximum deviation of each marker on the vessel model.

Results

As expected, stent retrievers of the same type exhibited more vessel shifts when they had a larger diameter and longer length. On the other hand, stents with a segmental structure demonstrated less vessel deviation than those with a tubular structure, regardless of the large lumen and long length.

Conclusion

If the degree of vessel stress can be represented by a numerical value, areas where the careful use of different devices for neurointerventions is required may be able to be identified. Moreover, this method may be useful for training.

Ideas Developed from the Routine Use of Problem-solving Skills in Neuroendovascular Therapy

Objective

All physicians should endeavor to perform safe and rapid neuroendovascular operations. We describe the process of identifying novel methods and highlight some representative clinical examples from our practice.

Methods

We made a habit of asking questions regarding problems encountered during operations. Potential solutions are often identified and noted in our smartphones or as memos. These solutions are then evaluated by experiments in vascular models before assessing their efficacy in clinical settings.

Results

Some ideas based on our process of raising problems and finding solutions were published, and found to be relevant to the wider scientific community. Moreover, all ideas were applicable in most settings due to the use of conventional, familiar, and cheap methods and equipment. The paper rail method, modified pigtail shape microguidewire, microcatheter in vivo printing method, microcatheter shaping cast, and wireless trans-cell approach are presented as representative ideas.

Conclusions

We reported methods of neuroendovascular therapy identified through the routine practice of problem-solving by our team.