Introduction Repeated number of passes, clot fragmentation, and distal embolization during mechanical thrombectomy lead to worse clinical outcomes in acute ischemic stroke.
Aim of Study This study aims to assess the recanalization and embolic outcomes of different stent-retrievers (SR): open-tip SR (Solitaire X 6x40 mm), closed-tip SR (Embotrap II 5x33 mm), and filter-tip SR (NeVa NET 5.5x37 mm).
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 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 >1 mm 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 (>1 mm) 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 (>1 mm) that embolize distally during an MT procedure, potentially increasing the chances of first-pass complete recanalization.
Disclosure of Interest MR received research funding from Medtronic and
Vesalio MR declares ownership of Anaconda Biomed and Methinks shares. MR received consulting fees from Anaconda Biomed, Apta Targets, Medtronic, Stryker,
Cerenovus, and Philips. AT reports receiving consulting fees from Anaconda Biomed,
Balt, Medtronic, MicroVention, Cerus, Merlin Medical, and Stryker. J-HB
Received consulting fees from MicroVention, Stryker, Vesalio, and Acandis. PB received consulting fees from Perflow Medical, Phenox, Cerenovus, Neurovasc, Brainomix, and
Perfuze DB received consulting fees from Acandis and Balt.
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