Background Large clot burden and fibrin clots remain challenging for mechanical thrombectomy. The aim of this study is to assess a new-generation aspiration system with hydro-separator technology that works regardless of clot size or composition.
Materials and Methods The Neurostar thrombectomy system is comprised of a 6F Neurostar catheter and a Saline Drive Unit (SDU) with a peristaltic pump, which creates a stream of saline on the tip of the catheter to macerate the thrombus during aspiration (hydro-separator). The Neurostar catheter as well as two commercially available thrombectomy devices, the Solitaire FR stent retriever and Sofia Plus aspiration catheter, were tested to compare single-pass recanalization performance in challenging situations. Fibrous clots and cohesive erythrocyte-rich clots were produced from porcine blood. A segment of fibrous clot was placed in the MCA distal to M1 and proximal to M2 in a tortuous in-vitro intracranial vascular model, or a relatively long (20 mm) erythrocyte-rich clot was placed in the middle segment of the M1. Mechanical thrombectomy using each device was repeated 10 times with fibrous clots and erythrocyte-rich clots. Success recanalization was defined as clot removal without visible fragmentation or migration.
Results The Neurostar catheter led to significantly better single-pass recanalization performance (18/20) compared to the Sofia Plus aspiration catheter (11/20) and Solitaire FR stent retriever (10/20). All of the recanalization procedures with the Sofia Plus required complete removal of the catheter because the clot was stuck at the tip or could not be ingested entirely. In contrast, the Neurostar catheter could ingest the clot and remain at the site of occlusion in all of the successful single pass recanalization procedures.
Conclusions Mechanical thrombectomy with the new aspiration system with hydro-separator resulted in higher success rates than a commercially available stent retriever and aspiration catheter in this experimental model. Further in vivo studies should be performed to confirm its performance.
Disclosures N. Kaneko: 2; C; Walk Vascular. L. Guo: None. Y. Komuro: None. S. Tateshima: 2; C; Walk Vascular, Medtronic.
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