Background Despite high recanalization rates achieved with endovascular treatment of acute ischemic strokes, around 50% of eligible patients will not achieve a good outcome. Parameters that may determine patient outcomes include: time from puncture to recanalization, the collateral status, the anesthesia regimen, blood pressure management, and distal emboli. Characterization of distal emboli generated during mechanical thrombectomy has been performed in previous studies.
Objective To further investigate the risk of distal embolization associated with microcatheter navigation across the clot.
Methods A contrast-enhanced clot analog was used in an in vitro model that mimicked a middle cerebral artery occlusion within a complete circle of Willis vascular replica. The clot was crossed with one of the following microcatheters: Pro18, XT-27 or 3MAX. The emboli generated during the procedure were collected and measured.
Results The use of Pro18 and XT-27 resulted in a significant reduction of visible particles (size ≥500 µm) as compared with the 3MAX catheter (P<0.003). For the size range between 8 and 200 µm, there was a trend for Pro18 to generate fewer particles (−18%) than XT-27 but without statistical significance (P>0.05). In comparison with previously published data, acquired under the same conditions, it was found that the clot crossing maneuver accounts approximately for 12% of the total number of small emboli (<200 µm) induced during a stent retriever-mediated mechanical thrombectomy procedure via a balloon guide catheter.
Conclusions The clot crossing maneuver has a significant effect on the total number of small particles induced during mechanical thrombectomy. Smaller microcatheter sizes should be favored when possible.
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Contributors JC: designed the study, designed and performed the experiments, analyzed and interpreted the data, drafted the manuscript, approved the final manuscript and agrees to be accountable for the accuracy and integrity of the work. RMK, MJG, J-YC: designed the study, designed and performed the experiments, analyzed and interpreted the data, revised the manuscript, approved the final manuscript and agree to be accountable for the accuracy and integrity of the work. RA, MM, ETL: designed and performed the experiments, analyzed and interpreted the data, revised the manuscript, approved the final manuscript and agree to be accountable for the accuracy and integrity of the work.
Funding Partially supported by research grants from the Fulbright Program, the Philippe Foundation, and the French society of Radiology (Bourse de Recherche SFR-CERF).
Competing interests JC has received educational grant from Microvention/Terumo and Medtronic. MM, J-YC: fee-for-service consulting for Stryker Neurovascular, ETL: fee-for-service consulting for Imperative Care, InNeuroCo, Route 92 Medical, StrykerNeurovascular. MJG: as been a consultant on a fee-per-hour basis for Cerenovus, Imperative Care, InNeuroCo, Medtronic Neurovascular, Phenox, Route 92 Medical, Stryker Neurovascular; holds stock in InNeuroCo, Imperative Care and Neurogami; and has received research support from the National Institutes of Health (NIH), Anaconda, Cerenovus, Cook Medical, Gentuity, Imperative Care, InNeuroCo, Magneto, Microvention, Medtronic Neurovascular, MIVI Neurosciences, Neuravi, Neurogami, Philips Healthcare, Rapid Medical, Route 92M, Stryker Neurovascular, and the Wyss Institute.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Raw data will be available upon request to the corresponding author.