Purpose Balloon Guide Catheter (BGC) aspiration is becoming increasingly recognized as an important adjunctive technique to stroke thrombectomy for improving first pass recanalization as well as clinical outcomes. Currently, BGC aspiration requires two operators, one for thrombectomy and second for staged BGC aspiration using a manual syringe. Automating BGC aspiration using a customizable iPad app and a smart pump would enable stroke thrombectomy to be performed with a single operator, and potentially help alleviate some of the manpower challenges for 24/7 coverage for stroke thrombectomies globally.
Methods Phase 1: Staged BGC aspiration (increasing suction levels – initially low, then medium, then high – to avoid vessel collapse) is manually performed by an experienced operator using a 60 cc syringe and a standard BGC (9F Merci BGC, Stryker Corp., MI). The suction intensity levels for low, medium, and high (in inHg) are measured using a vacuum gauge (DuraChoice, Irving, TX). The duration (in seconds) at each of these levels is measured. Phase 2: the Mean suction levels and duration (low, medium, high, followed by pause or end of suction) from three sample measurements are entered into a customizable iPad app (CLEARTM Pro, Insera Therapeutics, Inc.) to create an automated BGC suction pattern (figure 1). Phase 3: With a BGC positioned in an in-vitro flow model simulating stroke thrombectomy (United Biologics, CA), the feasibility of automating staged BGC aspiration is assessed by pressing the customized BGC pattern on the iPad app. The iPad app activates a bluetooth-enabled smart pump (CLEARTM Aspiration System, Insera Therapeutics, Inc.) connected to the BGC.
Results Phase 1 testing was performed and the suction intensity levels for staged BGC aspiration and duration (values rounded to nearest integer) were noted. Low suction ranged from 10–13 inHg (Mean: 12 inHg) with a duration ranging from 11–17 s (Mean: 13 s), Medium suction ranged from 15–18 inHg (Mean: 16 inHg) with a duration ranging from 8–11 s (Mean: 9 s), and High suction ranged from 24–26 inHg (Mean: 25 inHg) with a duration ranging from 19–25 s (Mean: 22 s), The total duration of staged BGC aspiration ranged from 39–53 s with a 60 s safety pause or end of suction prior to another retrieval attempt. Phases 2 and 3 were successfully performed to create a customized BGC aspiration pattern and staged BGC aspiration was automated during simulated stroke thrombectomy (figure 1).
Conclusion Automation of staged BGC aspiration is feasible using a customizable iPad app and a bluetooth-enabled smart pump.
Disclosures B. Jagadeesan: None. V. Janardhan: 4; C; Insera Therapeutics, Inc. V. Janardhan: 4; C; Insera Therapeutics, Inc.
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