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Stent retriever thrombectomy with the Cover accessory device versus proximal protection with a balloon guide catheter: in vitro stroke model comparison
  1. Maxim Mokin1,2,
  2. Swetadri Vasan Setlur Nagesh3,4,5,
  3. Ciprian N Ionita3,6,
  4. J Mocco7,
  5. Adnan H Siddiqui6,8,9
  1. 1Department of Neurosurgery, University of South Florida College of Medicine, Tampa, Florida, USA
  2. 2Department of Neurology, University of South Florida College of Medicine, Tampa, Florida, USA
  3. 3Department of Biomedical Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA
  4. 4Department of Electrical Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA
  5. 5Department of Mechanical and Aerospace Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA
  6. 6Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA
  7. 7Departments of Neurological Surgery and Radiology and Radiological Sciences, Mount Sinai Health System, New York, New York, USA
  8. 8Departments of Neurosurgery and Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA
  9. 9Jacobs Institute, Buffalo, New York, USA
  1. Correspondence to Dr A H Siddiqui, University at Buffalo Neurosurgery, 100 High Street, Suite B4, Buffalo, NY 14203, USA; asiddiqui{at}ubns.com

Abstract

Background Recently, an in vitro cerebrovascular occlusion model of the intracranial circulation was developed for testing thrombectomy devices. The Cover accessory (Lazarus Effect; Campbell, California, USA) is a novel nitinol braided mesh device that surrounds the stent retrieval device and thrombus during the retrieval process to help prevent clot fragmentation and embolization.

Methods Using the in vitro model, after introducing fresh clot into the middle cerebral artery, we compared rates of target vessel recanalization and embolization in new territories (areas in which clot had not been introduced) achieved with the Solitaire Flow Restoration (FR) stent retriever (Covidien, Irvine, California) in conjunction with the use of a conventional guide catheter (control group), a balloon guide catheter (BGC group), and the Cover device (Cover group).

Results In a total of 51 thrombectomy experiments (20 in the control group, 20 in the BGC group, and 11 in the Cover group), successful recanalization (Thrombolysis in Cerebral Infarction 2b–3) was achieved more frequently in the Cover group than in the control group or in the BGC group (p=0.047 and p=0.020, respectively). Embolization of new (previously unaffected) territories occurred in five (25%) experiments from the control group and in three (15%) experiments from the BGC group, whereas no embolization of new territories was seen with Cover device assisted thrombectomy.

Conclusions Application of the Cover device in this experimental model resulted in higher successful recanalization rates, no embolic events, and was more effective than use of the conventional guide catheter or BGC.

  • Stroke
  • Stent
  • Thrombectomy

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