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  • Impact of stent-retriever tip design on distal embolization during mechanical thrombectomy: a randomized in vitro evaluation

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Basic science
Original research
Impact of stent-retriever tip design on distal embolization during mechanical thrombectomy: a randomized in vitro evaluation
  1. Jiahui Li1,2,
  2. Riccardo Tiberi1,2,
  3. Pervinder Bhogal3,
  4. Jan-Hendrik Buhk4,
  5. Daniel Behme5,
  6. Alejandro Tomasello1,6,
  7. Marc Ribo1,2
  1. 1 Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
  2. 2 Stroke Unit, Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
  3. 3 Neuroradiology, The Royal London Hospital, Barts NHS Trust, London, UK
  4. 4 Neuroradiology, Asklepios Hospital Hamburg St Georg, Hamburg, Germany
  5. 5 Neuroradiology, University Medical Center Magdeburg, Magdeburg, Germany
  6. 6 Interventional Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
  1. Correspondence to Dr Marc Ribo, Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona 08035, Spain; marcriboj{at}hotmail.com

Abstract

Background Repeated number of passes, clot fragmentation, and distal embolization during mechanical thrombectomy (MT) lead to worse clinical outcomes in acute ischemic stroke. This study aimed to assess the recanalization and embolic outcomes of different stent-retrievers (SRs): open-tip SR (Solitaire X 6×40 mm), closed-tip SR (EmboTrap II 5×33 mm), and filter-tip SR (NeVa NET 5.5×37 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 (>100 µm) 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>1 mm from embolizing distal territories in 44% of cases, compared with 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 arm (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, which in turn may increase the chances of first-pass complete recanalization.

  • device
  • embolic
  • intervention
  • stent
  • stroke

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.

https://doi.org/10.1136/jnis-2023-020382

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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.

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    Footnotes

    • Twitter @marcriboj

    • Contributors Conception and design: MR, JL, PB, J-HB, DB, AT. Data acquisition: JL, RT. Data analysis and interpretation: JL, MR. Drafting the manuscript: JL, MR. Technical/material support: MR, AT. Critically revising the article: MR, PB, J-HB, DB, AT. Reviewed submitted version of the manuscript: all authors. MR accepts full responsibility for the work and the conduct of the study, had access to the data and controlled the decision to publish.

    • Funding This study was supported by Vesalio through an unrestricted grant.

    • Competing interests 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.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.