Skip to main content

Advertisement

SpringerLink
Log in

Preclinical testing of a new clot-retrieving wire device using polyvinyl alcohol hydrogel vascular models

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

Cerebral embolism is the principal cause of cerebral infarction. Recently, mechanical embolectomy has been proposed as an effective method. We performed a preclinical evaluation of a new mechanical clot-retrieving wire.

Methods

This clot-retrieving wire consisted of three nitinol loops at the tip of a microguidewire. These three loops could be collapsed into a 0.018-inch wire compatible microcatheter. Each loop was 8 mm long and 3.5 mm wide. For simulation, polyvinyl alcohol (PVA) vascular anatomical models of the human carotid (eight models) and vertebrobasilar (three models) circulation were constructed. A pulsatile flow circulation system was used. Embolic clots were produced using pig blood plasma. The microcatheter and the microguidewire were advanced beyond the clot. The wire was then exchanged for the retrieving wire. The microcatheter was then pulled slightly back to open the loops. The clot was then caught by withdrawal of the system. Once caught, the clot was retrieved to the guiding catheter tip. We investigated the following points: ease of device deployment, clot capture ability, clot removal against blood flow and removal of the clot out of the introducer system.

Results

A total of 104 procedures were performed in 11 PVA models and evaluated. The drop rate was 19%. We succeeded in partial and total recanalization in 51.0% of the procedures (53/104) within 30 minutes.

Conclusion

This new clot-retrieving wire could be useful for mechanical clot extraction in stroke.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Multicentre Acute Stroke Trial—Italy (MAST-I) Group (1995) Randomised controlled trial of streptokinase, aspirin, and combination of both in treatment of acute ischaemic stroke. Lancet 346:1509–1514

    Google Scholar 

  2. Hommel M, Boissel JP, Cornu C, Boutitie F, Lees KR, Bessorn G, Leys D, Amarenio P, Bogart M (1995) Termination of trial of streptokinase in severe acute ischaemic stroke. MAST Study Group. Lancet 345:57

    Article  PubMed  CAS  Google Scholar 

  3. Donnan GA, Davis SM, Chambers BR, Gates PC, Hankey GJ, McNeil JJ, Rosen D, Stewart-Wynne EC, Tuc RR (1995) Trials of streptokinase in severe acute ischaemic stroke. Lancet 345:578–579

    Article  PubMed  CAS  Google Scholar 

  4. Multicenter Acute Stroke Trial—Europe Study Group (1996) Thrombolytic therapy with streptokinase in acute ischemic stroke. N Engl J Med 335:145–150

    Article  Google Scholar 

  5. Cornu C, Boutitie F, Candelise L, Boissel JP, Donnan GA, Hommel M, Jaillard A, Lees KR (2000) Streptokinase in acute ischemic stroke: an individual patient data meta-analysis: The Thrombolysis in Acute Stroke Pooling Project. Stroke 31:1555–1600

    PubMed  CAS  Google Scholar 

  6. Fletcher AP, Alkjaersig N, Lewis M, Tulevski V, Davies A, Brooks JE, Hardin WB, Landau WM, Raichle ME (1876) A pilot study of urokinase therapy in cerebral infarction. Stroke 7:135–142

    Google Scholar 

  7. Hanaway J, Torack R, Fletcher AP, Landau WM (1976) Intracranial bleeding associated with urokinase therapy for acute ischemic hemispheral stroke. Stroke 7:143–146

    PubMed  CAS  Google Scholar 

  8. Jahan R, Duckwiler GR, Kidwell CS, Sayre JW, Gobin YP, Villablanca JP, Saver J, Starkman S, Martin N, Vinuela F (1999) Intraarterial thrombolysis for treatment of acute stroke: experience in 26 patients with long-term follow-up. AJNR Am J Neuroradiol 20:1291–1299

    PubMed  CAS  Google Scholar 

  9. Arnold M, Schroth G, Nedeltchev K, Loher T, Remonda L, Stepper F, Sturzenegger M, Mattle HP (2002) Intra-arterial thrombolysis in 100 patients with acute stroke due to middle cerebral artery occlusion. Stroke 33:1828–1833

    Article  PubMed  Google Scholar 

  10. del Zoppo GJ, Higashida RT, Furlan AJ, Pessin MS, Powley HA, Gent M (1998) PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. Stroke 29:4–11

    PubMed  Google Scholar 

  11. Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F(1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II Study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 282:2003–2011

    Article  PubMed  CAS  Google Scholar 

  12. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587

    Article  Google Scholar 

  13. The ATLANTIS, ECASS, and NINDS rt-PA Study Group Investigators (2004) Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363:768–774

    Article  Google Scholar 

  14. Molina CA, Alexandrov AV, Demchuk AM, Saqqur M, Uchino K, Alvarez-Sabin J (2004) Improving the predictive accuracy of recanalization on stroke outcome in patients treated with tissue plasminogen activator. Stroke 35:151–157

    Article  PubMed  CAS  Google Scholar 

  15. Trouillas P, Derex L, Philippeau F, Nighoghossian N, Honnorat J, Hanss M, Ffrench P, Adeleine P, Dechavanne M (2004) Early fibrinogen degradation coagulopathy is predictive of parenchymal hematomas in cerebral rt-PA thrombolysis. A study of 157 cases. Stroke 35:1323–1328

    Article  PubMed  CAS  Google Scholar 

  16. Lee KY, Kin DI, Kim SH, Lee SI, Chung HW, Shim YW, Kim SM, Heo JH (2004) Sequential combination of intravenous recombinant tissue plasminogen activator and intra-arterial urokinase in acute ischemic stroke. AJNR Am J Neuroradiol 25:1470–1475

    PubMed  Google Scholar 

  17. Ribo M, Molina CA, Rovira A, Quintana M, Delgado P, Montaner J, Grive E, Arenillas JF, Alvarez-Sabin J (2005) Safety and efficacy of intravenous tissue plasminogen activator stroke treatment in the 3- to 6-hour window using multimode transcranial Doppler/MRI selection protocol. Stroke 36:602–606

    Article  PubMed  CAS  Google Scholar 

  18. Eckert B, Kucinski T, Neumaier-Probst E, Fiehler J, Rother J, Zeumer H (2003) Local intra-arterial fibrinolysis in acute hemispheric stroke: effect of occlusion type and fibrinolytic agent on recanalization success and neurological outcome. Cerebrovasc Dis 15:258–263

    Article  PubMed  CAS  Google Scholar 

  19. Bourekas EC, Slivka AP, Shah R, Sunshine J, Suarez JI (2004) Intraarterial thrombolytic therapy within 3 hours of the onset of stroke. Neurosurgery 54:39–44

    Article  PubMed  Google Scholar 

  20. Johnson DM, Kramer DC, Cohen E, Rochon M, Rosner M, Weinberger J (2005) Thrombolytic therapy for acute stroke in late pregnancy with intra-arterial recombinant tissue plasminogen activator. Stroke 36:e53–e55

    Article  PubMed  Google Scholar 

  21. Fava M, Loyola S, Huete I (2000) Massive pulmonary embolism: treatment with the Hydrolyser thrombectomy device. J Vasc Interv Radiol 11:1159–1164

    PubMed  CAS  Google Scholar 

  22. Bellon RJ, Putman CM, Budzik RF, Pergolizzi RS, Reinking GF, Norbash AM (2001) Rheolytic thrombectomy of the occluded internal carotid artery in the setting of acute ischemic stroke. AJNR Am J Neuroradiol 22:526–530

    PubMed  CAS  Google Scholar 

  23. Nishida T, Nakamura M, Tsunoda T, Iijima R, Shiba M, Wada M, Nakajima R, Kitagawa Y, Yajima S, Wakayama M, Shibuya K, Yamaguchi T (2002) A case of acute myocardial infarction treated with a new thrombectomy system. Catheter Cardiovasc Interv 55:239–243

    Article  PubMed  Google Scholar 

  24. Siegel RJ, Gunn J, Ahsan A, Fishbein MC, Bowes RJ, Oakley D, Wales C, Steffen W, Campbell S, Nita H, Wills T, Silverton P, Myler RH, Cumberland DC (1994) Use of therapeutic ultrasound in percutaneous coronary angioplasty: experimental in vitro studies and initial clinical experience. Circulation 89:1587–1592

    PubMed  CAS  Google Scholar 

  25. Rosenschein U, Roth A, Rassin T, Basan S, Laniado S, Miller HI (1997) Analysis of coronary ultrasound thrombolysis endpoints in acute myocardial infarction (ACUTE trial): results of the feasibility phase. Circulation 95:1411–1441

    PubMed  CAS  Google Scholar 

  26. Berlis A, Lutsep H, Barnwell S, Norbash A, Wechsler L, Jungreis CA, Woolfenden A, Redekop G, Hartmann M, Schumacher M. (2004) Mechanical thrombolysis in acute ischemic stroke with endovascular photoacoustic recanalization. Stroke 35:1112–1116

    Article  PubMed  Google Scholar 

  27. Smikahl J, Yeung D, Wang S, Semba CP (2005) Alteplase stability and bioactivity after low-power ultrasonic energy delivery with the OmniSonics resolution system. J Vasc Interv Radiol 16:385–389

    PubMed  Google Scholar 

  28. Mayer TE, Hamann GF, Brueckmann HJ (2002) Treatment of basilar artery embolism with a mechanical extraction device: necessity of flow reversal. Stroke 33:2232–2235

    Article  PubMed  Google Scholar 

  29. Martinez H, Zoarski GH, Obuchowski AM, Stallmayer MJ, Papangelou A, Airan-Javia S (2004) Mechanical thrombectomy of the internal carotid artery and middle cerebral arteries for acute stroke by using the retriever device. AJNR Am J Neuroradiol 25:1812–1815

    PubMed  Google Scholar 

  30. Becker KJ, Brott TG (2005) Approval of the MERCI clot retriever. A critical view. Stroke 36:400–403

    Article  PubMed  Google Scholar 

  31. Ohta M, Handa A, Iwata H, Rufenacht DA, Tsutsumi S (2004) Poly-vinyl alcohol hydrogel vascular models for in vitro aneurysm simulations: the key to low friction surfaces. Technol Health Care 12:225–233

    PubMed  Google Scholar 

  32. Roach MR, Scott S, Ferguson GG (1972) The hemodynamic importance of the geometry of bifurcations in the circle of Willis (glass model studies). Stroke 3:255–267

    PubMed  CAS  Google Scholar 

  33. Steiger HJ, Liepsch DW, Poll A, Reulen HJ (1988) Hemodynamic stress in terminal saccular aneurysms: a laser-Doppler study. Heart Vessels 4:162–169

    Article  PubMed  CAS  Google Scholar 

  34. Kerber CW, Heilman C (1992) Flow dynamics in the human carotid artery: I. Preliminary observations using a transparent elastic model. AJNR Am J Neuroradiol 13:173–180

    PubMed  CAS  Google Scholar 

  35. Gailloud P, Muster M, Piotin M, Mottu F, Murphy KJ, Fasel JHD, Ruefenacht DA (1999) In vitro models of intracranial arteriovenous fistulas for the evaluation of new endovascular treatment materials. AJNR Am J Neuroradiol 20:291–295

    PubMed  CAS  Google Scholar 

  36. Sugiu K, Martin JB, Jean B, Gailloud P, Mandai S, Ruefenacht DA (2003) Artificial cerebral aneurysm model for medical testing, training, and research. Neuro Med Chir (Tokyo) 43:69–73.3

    Article  Google Scholar 

Download references

Conflict of interest statement

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Neuroradiology Unit, University Hospital of Geneva, 1211, Geneva, Switzerland

    Fumio Asakura, Hasan Yilmaz, German Abdo, Diego San Millan, Luca Augsburger, Daniel A. Ruefenacht & Karl-Olof Lovblad

  2. Neurology Department, University Hospital of Geneva, Geneva, Switzerland

    Lucka Sekoranja, Roman Sztajzel & Fabienne Perren

  3. Neuroendovascular Section, Brain Attack Center, Ohta Memorial Hospital, Ohta, Japan

    Katsuya Goto

Authors
  1. Fumio Asakura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hasan Yilmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. German Abdo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lucka Sekoranja
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Diego San Millan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luca Augsburger
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Roman Sztajzel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daniel A. Ruefenacht
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Fabienne Perren
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Karl-Olof Lovblad
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Katsuya Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karl-Olof Lovblad.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Asakura, F., Yilmaz, H., Abdo, G. et al. Preclinical testing of a new clot-retrieving wire device using polyvinyl alcohol hydrogel vascular models. Neuroradiology 49, 243–251 (2007). https://doi.org/10.1007/s00234-006-0181-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-006-0181-1

Keywords

Search

Navigation