Background The amount of force applied on a device is an important measure to evaluate the endovascular and surgical device manipulations. The measure has not been evaluated for neuroenodvascular procedures.
Purpose We aimed to study the use of force measure as a novel approach to test distal access catheter (DAC) performance during catheterization of cervical and intracranial vessels using patient specific 3-dimentional (3D) phantoms.
Methods Using patient specific 3D phantoms of the cervical and intracranial circulation, we recorded measure of force required to deliver three types of DACs beyond the ophthalmic segment of the internal carotid artery. Six different combinations of DAC–microcatheter–guidewire were tested. We intentionally included what we considered suboptimal combinations of DACs, microcatheters, and guidewires during our experiments to test the feasibility of measuring force under different conditions. A six axis force sensor was secured to the DAC with an adjustable torque used to track axially directed push and pull forces required to navigate the DAC to the target site.
Results In a total of 55 experiments, we found a significant difference in the amount of force used between different DACs (mean force for DAC A, 1.887±0.531N; for DAC B, 2.153±1.280 N; and for DAC C, 1.194±0.521 N, P=0.007). There was also a significant difference in force measures among the six different catheter systems (P=0.035).
Conclusions Significant difference in the amount of force used between different DACs and catheter systems were recorded. Use of force measure in neuroendovascular procedures on 3D printed phantoms is feasible.
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Contributors MM, MW, and AHS: study concept and design. MM, MW, SVSN, and NVK performed the experiments. MW: statistical analysis. MM and MW wrote the manuscript. All authors participated in data collection and analysis, edited the manuscript, and approved the final version.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests EIL: shareholder/ownership interests in Intratech Medical Ltd, Blockade Medical LLC, and Medina Medical; principal investigator for Covidien US SWIFT PRIME trials; honoraria for training and lecturing from Covidien; consultant for Pulsar, Medina Medical, and Blockade Medical; other financial support from Abbott for carotid training for physicians. MM: consultant for Toshiba (Canon) Medical, Cerebrotech, and Imperative Care. AHS: grants from National Institutes of Health/NINDS/NIBIB and University at Buffalo–none related to the present study; financial interests in Hotspur, Intratech Medical, StimSox, Valor Medical, Blockade Medical, and Lazarus Effect; consultant for Codman and Shurtleff Inc, Concentric Medical, ev3/Covidien Vascular Therapies, GuidePoint Global Consulting, Penumbra, Stryker, Pulsar Vascular, MicroVention, Lazarus Effect, and Blockade Medical; speakers’ bureau from Codman and Shurtleff Inc; National Steering Committee for Penumbra Inc’s 3D Separator Trial, Covidien’s SWIFT PRIME trial, and MicroVention’ s FRED trial; advisory boards for Codman and Shurtleff, and Covidien Neurovascular; honoraria from Abbott Vascular, Codman and Shurtleff, and Penumbra Inc.
Patient consent Not required.
Ethics approval The collection of clinical data for this study was approved by the institutional review board.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data are presented in this paper.