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Abstracts
2.3 ISCHEMIC – Treatment
P154/193  Impact of stent-retriever tip design on distal embolization during mechanical thrombectomy: a randomized in vitro evaluation
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  1. Jiahui Li1;2,
  2. Riccardo Tiberi1;2,
  3. Pervinder Bhogal3,
  4. Jan-Hendrik Buhk4,
  5. Daniel Behme5,
  6. Alejandro Tomasello2;6,
  7. Marc Ribo1;2
  1. 1Vall d´Hebron University Hospital, Stroke Unit, Barcelona, Spain
  2. 2Vall d’Hebron Research Institute, Stroke Research, Barcelona, Spain
  3. 3The Royal London Hospital, Barts NHS Trust, Neuroradiology, London, UK
  4. 4Asklepios Hospital Hamburg St. Georg, Neuroradiology, Hamburg, Germany
  5. 5University Medical Center Magdeburg, Neuroradiology, Magdeburg, Germany
  6. 6Vall d´Hebron University Hospital, Interventional Neuroradiology, Barcelona, Spain

Abstract

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.

http://dx.doi.org/10.1136/jnis-2023-ESMINT.182

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