Article Text
Abstract
Background In mechanical thrombectomy (MT), distal access catheters (DACs) are tracked through the vascular anatomy to reach the occlusion site. The inability of DACs to reach the occlusion site has been reported as a predictor of unsuccessful recanalization. This study aims to provide insight into how to navigate devices through the vascular anatomy with minimal track forces, since higher forces may imply more risk of vascular injuries.
Methods We designed an experimental setup to monitor DAC track forces when navigating through an in vitro anatomical model. Experiments were recorded to study mechanical behaviors such as tension buildup against vessel walls, DAC buckling, and abrupt advancements. A multiple regression analysis was performed to predict track forces from the catheters’ design specifications.
Results DACs were successfully delivered to the target M1 in 60 of 63 in vitro experiments (95.2%). Compared to navigation with unsupported DAC, the concomitant coaxial use of a microcatheter/microguidewire and microcatheter/stent retriever anchoring significantly reduced the track forces by about 63% and 77%, respectively (p<0.01). The presence of the braid pattern in the reinforcement significantly reduced the track forces regardless of the technique used (p<0.05). Combined coil and braid reinforcement configuration, as compared with coil alone, and a thinner distal wall were predictors of lower track force when navigating with unsupported DAC.
Conclusions The use of microcatheter and stent retriever facilitate smooth navigation of DACs through the vascular tortuosity to reach the occlusion site, which in turn improves the reliability of tracking when positioning the DAC closer to the thrombus interface.
- Stroke
- Thrombectomy
- Catheter
- Navigation
- Vessel Wall
Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. 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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Data availability statement
Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Data relevant to the study are included in the article. All data are available upon reasonable request to the corresponding author.
Footnotes
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Contributors JL, MRi, AT, and OC conceived of the study and experimental setup design. JL, PC, and RT performed the experiments and statistical analyses. MRi and MRe reported the clinical case. JL and MRi drafted the manuscript. The article was critically revised by JL, MRi, MRe, DFK, IG, OC, and EE. All authors approved the final version of the manuscript. MRi is the guarantor of the article.
Funding This work was funded by the European Regional Development Fund (FEDER), the Spanish Ministry of Science and Innovation (MICINN), and the State Research Agency (AEI) with the Projects (RTI2018-096320-B-C21, and RTI2018-097038-B-C22), the European Commission-Euronanomed nAngioderm Project (JTC2018-103) funded through the Spanish Ministry of Science and Innovation (ref. PCI2019-103648), the Spanish network of cell therapy (TERCEL), the Programme/Generalitat de Catalunya (2017-SGR-359) and the Severo Ochoa Programme of the Spanish Ministry of Science and Innovation (MICINN—Grant SEV-2014–0425, 2015–2019 and CEX2018-000789-S, 2019–2023).
Competing interests MRi reports ownership of Anaconda Biomed, and Methinks shares, personal fees from Apta Targets, Medtronic, Stryker, Cerenovus, Philips, and Balt. AT reports receiving personal fees from Anaconda Biomed, Balt, Medtronic, Perflow, and Stryker. DFK reports royalty payments from Medtronic, ownership of Conway Medical, LLS; Marblehead Medical, LLC; Superior Medical Experts, LLC; Nested Knowledge, LLC, research support from Medtronic, MicroVention, Stryker, Balt, Insera Therapeutics, and Cerenovus. IG reports ownership of Anaconda Biomed shares and he is currently an employee of Anaconda Biomed. The other authors have no conflicts of interest to declare that are relevant to the content of this article.
Provenance and peer review Not commissioned; externally peer reviewed.
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