Introduction Endovascular treatment of stroke, although highly effective, may fail to reach complete recanalization in around 20% of cases. The Advanced Thrombectomy System (ANCD) is a novel stroke thrombectomy device designed to reduce clot fragmentation and facilitate retrieval by inducing local flow arrest and allowing distal aspiration in combination with a stent retriever. We aimed to assess the preclinical efficacy of ANCD.
Methods Soft red blood cell (RBC)-rich (n=20/group) and sticky fibrin-rich (n=30/group) clots were used to create middle cerebral artery (MCA) occlusions in two vascular phantoms. Three different treatment strategies were tested: (1) balloon guide catheter + Solitaire (BGC+SR); (2) distal access catheter + SR (DAC+SR); and (3) ANCD+SR, until complete recanalization was achieved or to a maximum of three passes. The recanalization rate was determined after each pass.
Results After one pass, ANCD+SR resulted in an increased recanalization rate (94%) for all clots together compared with BGC+SR (66%; p<0.01) or DAC+SR (80%; p=0.04). After the final pass the recanalization rate increased in all three groups but remained higher with ANCD+SR (100%) than with BGC+SR (74%; p<0.01) or DAC+SR (90%; p=0.02). The mean number of passes was lower with ANCD+SR (1.06) than with BGC+SR (1.46) or DAC+SR (1.25) (p=0.01). A logistic regression model adjusted for treatment arm, clot type, and model used showed that both RBC-rich clots (OR 8.1, 95% CI 1.6 to 13.5) and ANCD+SR (OR 3.9, 95% CI 1.01 to 15.8) were independent predictors of first-pass recanalization.
Conclusion In in vitro three-dimensional models replicating MCA-M1 occlusion, ANCD+SR showed significantly better recanalization rates in fewer passes than other commonly used combinations of devices.
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Contributors SS, IC, HV, AR, IG, TA, RN, TJ, MR: study design, data acquisition, critical revision of the manuscript. MR drafted the manuscript. All the authors made a substantial contribution to the conception and design of the work, revised the paper for intellectual content, and gave final approval of the version to be published.
Funding Anaconda Biomed provided funding for the study.
Competing interests SS, IC, HV, AR, and IG are employees of Anaconda Biomed. MR and TJ are shareholders in Anaconda Biomed. TA and RN are clinical consultants for Anaconda Biomed. RN is a consultant/advisory board member for Stryker Neurovascular and Covidien. Stryker Neurovascular (Trevo-2 trial principal investigator–modest; DAWN trial principal investigator–no compensation; TREVO registry steering committee–no compensation), Medtronic (SWIFT trial steering committee–modest; SWIFT-Prime trial steering committee–no compensation; STAR Trial Angiographic Core Lab–significant), Penumbra (3D Separator trial executive committee–no compensation), Neuravi (ARISE-2 steering committee–no compensation), Genentech (physician advisory board–modest), Allm Inc (physician advisory board–no compensation). TA is a consultant for Ablynx, Amnis Therapeutics, Anaconda,Cerenovus/Neuravi, Medtronic, Rapid Medical. MR is a consultant for Cerenovus, Medtronic, Stryker, Apta Targets and Vesalio. TJ is a consultant for Stryker Neurovascular (PI DAWN-unpaid); Ownership Interest: Anaconda; Advisory Board/Investor: FreeOx Biotech; Advisory Board/Investor: Route92; Advisory Board/Investor: Blockade Medical, Consultant; Honoraria: Cerenovus.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data that support the findings of this study are available from the corresponding author on reasonable request.
Patient consent for publication Not required.
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