You are here

Article Text

Article menu

Download PDFPDF

SNIS 20th annual meeting oral abstracts
O-013 Impact of stent-retriever tip design on distal embolization during mechanical thrombectomy – a randomized in vitro evaluation
Free
  1. J Li1,
  2. R Tiberi1,
  3. P Bhogal2,
  4. J Buhk3,
  5. D Behme4,
  6. A Tomasello1,
  7. M Ribo1
  1. 1Stroke Research, Vall d’Hebron Research Institute, Barcelona, Spain
  2. 2Interventional Neuroradiology, The Royal London Hospital, Barts NHS Trust, London, UK
  3. 3Neuroradiology, Asklepios Hospital Hamburg St.Georg, Hamburg, Germany
  4. 4Neuroradiology, University Medical Center Magdeburg, Magdeburg, Germany

Abstract

Background Repeated number of passes, clot fragmentation, and distal embolization during mechanical thrombectomy lead to worse clinical outcomes in acute ischemic stroke.

Objective To assess the recanalization and embolic outcomes of different stent-retrievers (SR): open-tip SR (Solitaire X 6x40mm), closed-tip SR (Embotrap II 5x33mm), and filter-tip SR (NeVa NET 5.5x37mm).

Methods Stiff-friable clot analogs were used to create middle cerebral artery (M1-MCA) occlusions in a benchtop model. After occlusion, experiments were randomized into one of the three treatment arms. The thrombectomy technique consisted of retrieving the SR into a balloon guide catheter under proximal flow arrest and continuous aspiration. A total of 150 single-attempt cases were performed (50 cases/treatment arm). Distal emboli (>100µm) were collected and analyzed after each experiment.

Results Filter-tip SR achieved a non-significantly higher first-pass recanalization rate than open-tip SR and closed-tip SR (66% vs. 48% vs. 44%; p=0.064). Filter-tip SR prevented clot fragments >1mm from embolizing distal territories in 44% of cases, compared to 16% in open-tip SR and 20% in closed-tip (p=0.003). There were no significant differences between treatment arms in terms of total emboli count (open-tip=19.2±13.1, closed-tip=19.1±10.7, filter-tip=17.2±13.0; p=0.660). Nonetheless, the number of large emboli (>1mm) and total area of emboli were significantly lower in the filter-tip arm (n=0.88±1.2, A=2.06±1.85 mm2) than in the closed-tip (n=2.34±3.38, A=4.06±4.80 mm2), p<0.05.

Conclusions When facing fragment-prone clots, the filter-tip SR significantly reduces the number of large clots (>1mm) that embolize distally during an MT procedure, which in turn may increase the chances of first-pass complete recanalization.

Abstract O-013 Figure 1
Abstract O-013 Figure 1

Disclosures J. Li: 1; C; Vesalio. R. Tiberi: 1; C; Vesalio. P. Bhogal: 1; C; Vesalio. 2; C; Perflow Medical, Phenox, Cerenovus, Neurovasc, Brainomix, Perfuze. 3; C; BRAIN Conference, BT Health Board. J. Buhk: 2; C; MicroVention, Stryker, Vesalio, Acandis. D. Behme: 1; C; Vesalio. 2; C; Acandis, Balt. A. Tomasello: 2; C; Medtronic, Balt, Cerus, Siemens, Vesalio. M. Ribo: 1; C; Vesalio. 2; C; Anaconda Biomed, Medtronic, Cerenovus, Stryker, Apta Targets, Philips.

https://doi.org/10.1136/jnis-2023-SNIS.13

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.