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Basic science
Original research
Quantitative assessment of device–clot interaction for stent retriever thrombectomy
  1. Kajo van der Marel1,
  2. Ju-Yu Chueh1,
  3. Olivia W Brooks1,
  4. Robert M King1,
  5. Miklos G Marosfoi1,
  6. Erin T Langan1,
  7. Sarena L Carniato2,
  8. Matthew J Gounis1,
  9. Raul G Nogueira3,
  10. Ajit S Puri1
  1. 1Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
  2. 2Department of Preclinical Science, Stryker Neurovascular, Fremont, California, USA
  3. 3Emory University School of Medicine/Grady Memorial Hospital-Marcus Stroke and Neuroscience Center, Atlanta, Georgia, USA
  1. Correspondence to Dr Matthew J Gounis, Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, 55 Lake Ave N, SA-107R, Worcester, MA 01655, USA; matt.gounis{at}umassmed.edu

Abstract

Purpose Rapid revascularization in emergent large vessel occlusion with endovascular embolectomy has proven clinical benefit. We sought to measure device–clot interaction as a potential mechanism for efficient embolectomy.

Methods Two different radiopaque clot models were injected to create a middle cerebral artery occlusion in a patient-specific vascular phantom. A radiopaque stent retriever was deployed within the clot by unsheathing the device or a combination of unsheathing followed by pushing the device (n=8/group). High-resolution cone beam CT was performed immediately after device deployment and repeated after 5 min. An image processing pipeline was created to quantitatively evaluate the volume of clot that integrates with the stent, termed the clot integration factor (CIF).

Results The CIF was significantly different for the two deployment variations when the device engaged the hard clot (p=0.041), but not the soft clot (p=0.764). In the hard clot, CIF increased significantly between post-deployment and final imaging datasets when using the pushing technique (p=0.019), but not when using the unsheathing technique (p=0.067). When we investigated the effect of time on CIF in the different clot models disregarding the technique, the CIF was significantly increased in the final dataset relative to the post-deployment dataset in both clot models (p=0.004–0.007).

Conclusions This study demonstrates in an in vitro system the benefit of pushing the Trevo stent during device delivery in hard clot to enhance integration. Regardless of delivery technique, clot–device integration increased in both clot models by waiting 5 min.

  • Stroke
  • Thrombectomy
  • Stent
  • Technique
  • CT

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/neurintsurg-2015-012209

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    Footnotes

    • KvdM and J-YC contributed equally.

    • Contributors KvdM and J-YC: designed the experiments, performed the experiments, analyzed and processed the data, drafted the manuscript. OWB and RMK: processed the data, revised the draft manuscript. MGM: performed the experiments, revised the manuscript. SLC: designed the experiments, revised the draft manuscript. MJG and RGN: designed the study, revised the draft manuscript. ASP: designed the study, performed the experiments, revised the draft manuscript.

    • Funding This work was supported by Stryker Neurovascular. Support for imaging systems is provided by Philips Healthcare. The content is solely the responsibility of the authors and does not represent the official views of Stryker or Philips.

    • Competing interests MJG: Has been a consultant on a fee-per-hour basis for Codman Neurovascular and Stryker Neurovascular; holds stock in InNeuroCo; and has received research support from the National Institutes of Health (NIH), Codman Neurovascular, Stryker Neurovascular, Microvention, Medtronic Neurovascular, Philips Healthcare, InNeuroCo, Neuronal Protection Systems, the Wyss Institute, and Silk Road. SLC: Employed by Stryker Neurovascular. RGN: Stryker Neurovascular (Trevo-2 Trial Principal Investigator—modest; DAWN Trial Principal Investigator—no compensation), Medtronic (SWIFT Trial Steering Committee—modest; SWIFT-Prime Trial Steering Committee—no compensation; STAR Trial Angiographic Core Lab—significant), Penumbra (3D Separator Trial Executive Committee—no compensation), Editor-In-Chief Interventional Neurology Journal (no compensation). ASP: Holds stock in InNeuroCo and has received research grants from Medtronic Neurovascular and Stryker Neurovascular.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement For access to the raw images obtained in this study, please contact the corresponding author.