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Abstract
Background Clinical outcome is improved with first-pass complete reperfusion during mechanical thrombectomy. Laboratory data have shown that both stent retriever and aspiration thrombectomy generates thousands of clot fragments, of which many cause embolism of smaller vessels within the vascular territory originally affected, or in a new vascular territory. A new retriever device (Neva Net, Vesalio, Lake Forest CA) has been innovated that includes a distal metallic mesh that serves as an embolic filter (figure 1). We hypothesized that incorporation of the filter within the stent retriever would reduce distal emboli.
Methods Simulated use mechanical thrombectomy was conducted in a validated middle cerebral artery occlusion in a vascular phantom. Briefly, a vascular replica of the entire circle of Willis was perfused with blood mimicking fluid at physiologically correct pressure and flows. A barium doped, bovine clot was introduced into the right ICA leading to complete occlusion of the right M1 segment of the MCA. The test article (Neva Net) was compared to gold standard stent-retriever thrombectomy with the Solitaire device (Medtronic, Irvine CA) and were block randomized with 10 replicate experiments for each device. All effluent was collected from the MCA and ACA territories separately for emboli analysis. We also measured the number of passes required to achieve complete recanalization.
Results In all experiments with the Neva Net, first-pass complete recanalization was achieved, whereas with the control device it was only 60% (p=0.03). The median number of clot fragments with a diameter of 1mm or more was 4-fold higher with the control device versus the Neva Net (p=0.037). More clot fragments with diameters between 0.2 and 1 mm were found in the control group versus the Neva Net (p=0.048).
Conclusion Stent-retrievers with integrated drop zones and distal embolic filter have increased first pass complete recanalization and reduce the amount of clot fragmentation leading to distal emboli.
Disclosures V. Anagnostakou: None. M. Epshtein: None. R. Nogueira: 2; C; Anaconda, Biogen, Cerenovus, Genentech, Philips, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, Synchron. 4; C; Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse, Q’Apel Medical Truvic, Vastrax, Viseonand Perfuze. M. Gounis: 1; C; Research support from the NIH, the United States – Israel Binational Science Foundation, Anaconda, ApicBio, Arsenal Medical, Axovant, Balt, Cerenovus, Ceretrieve, CereVasc LLC, Cook Medical, Galaxy Th. 2; C; Consultant on a fee-per-hour basis for Alembic LLC, Astrocyte Pharmaceuticals, BendIt Technologies, Cerenovus, Imperative Care, Jacob’s Institute, Medtronic Neurovascular, Mivi Neurosciences, phenox G. 4; C; Imperative Care, InNeuroCo, Galaxy Therapeutics, and Neurogami, and Synchron.