Background A direct aspiration first pass thrombectomy (ADAPT) is a fast-growing technique for which a broad catalog of catheters that provide a wide range of aspiration forces can be used. We aimed to characterize different catheters' aspiration performance on stiff clots in an in vitro vascular model. We hypothesized that labeled catheter inner diameter (labeled-ID) is not the only parameter that affects the aspiration force (asp-F) and that thrombus–catheter tip interaction and distensibility also play a major role.
Methods We designed an experimental setup consisting of a 3D-printed carotid artery immersed in a water deposit. We measured asp-F and distensibility of catheter tips when performing ADAPT on a stiff clot analog larger than catheter labeled-ID. Correlations between asp-F, catheter ID, and tip distensibility were statistically assessed.
Results Experimental asp-F and catheter labeled-ID were correlated (r=0.9601; P<0.01). The relative difference between experimental and theoretical asp-F (obtained by the product of the tip’s section area by the vacuum pressure) correlated with tip’s distensibility (r=0.9050; P<0.01), evidencing that ADAPT performance is highly influenced by catheter tip shape-adaptability to the clot and that the effective ID (eff-ID) may differ from the labeled-ID specified by manufacturers. Eff-ID showed the highest correlation with experimental asp-F (r=0.9944; P<0.01), confirming that eff-ID rather than labeled-ID should be considered to better estimate the device efficiency.
Conclusions Catheter tip distensibility can induce a significant impact on ADAPT performance when retrieving a stiff clot larger than the device ID. Our findings might contribute to optimizing thrombectomy strategies and the design of novel aspiration catheters.
Data availability statement
Data relevant to the study are included in the article. All data are available upon reasonable request to the corresponding author.
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Contributors JL, OC, and MR conceived the design, performed the experiments, analyzed the data, and drafted the manuscript. AT, MDL, PC, and EE made contributions to data interpretation and critical review for intellectual content.
Funding This study was funded by the European Commission-ERANET (nAngioderm JTC2018-103) and the Spanish Ministry MICINN for the funding support (MAT2015-62725-ERC, RTI2018-096320-B-C21, and RTI2018-097038-B-C22), the Severo Ochoa Program for Centers of Excellence and R&D 2016–2019, and Obra Social la Caixa (CaixaImpulse CI0015), the CERCA Program, and the Commission for Universities and Research of the Department of Innovation, Universities, and Enterprise of the Generalitat de Catalunya (SGR2017-359), CIBER-BBN, and the Spanish Network of Cell Therapy (TERCEL).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.