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E-132 Triple aspiration versus conventional aspiration techniques: an in-vitro randomized evaluation
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  1. C Bilgin1,
  2. J Li1,
  3. E Bayraktar1,
  4. R Naylor2,
  5. A Oliver3,
  6. Y Ueki2,
  7. J Cortese1,
  8. L Rinaldo2,
  9. R Kadirvel2,
  10. W Brinjikji1,
  11. H Cloft1,
  12. D Kallmes1
  1. 1Radiology, Mayo Clinic, Rochester, MN
  2. 2Neurosurgery, Mayo Clinic, Rochester, MN
  3. 3Biomechanical Engineering, Mayo Clinic, Rochester, MN

Abstract

Background and Purpose A singe aspiration maneuver using a large volume syringe is a common and effective technique for aspiration thrombectomy. Multiple aspiration cycles using large aspiration syringes has been proposed as a means to improve efficacy over single aspiration. In this study, we sought to investigate the efficacy of a ‘triple aspiration technique’ where a large volume syringe is cycled three times prior to catheter retraction during aspiration thrombectomy.

Methods A 3D-printed adult vasculature was used as a benchtop thrombectomy platform. A roller pump was used to circulate approximately 800 mL/min of 37°C water within the model. Fibrin-rich (stiff) and red blood cell-rich (soft) clots were prepared in 50 ml centrifuge tubes using human plasma, red blood cells, and calcium chloride. Next, clots were placed in the carotid terminus of the model, and the performances of three different aspiration techniques—triple syringe, single syringe, and continuous pump aspiration Riptide aspiration system (Medtronic, Bloomington. MN) —were compared in a randomized manner (1:1:1). Outcomes of interest included first-pass efficacy (FPE), final complete/near-complete recanalization (considered to be analogous to mTICI 2c/3), the number of thrombectomy attempts to achieve mTICI 2c/3, vacuum pressure, and distal embolization. The distal emboli were detected using a 70-micron cell strainer placed at the outflow of the model and quantified using a image processing algorithm. The vacuum pressures were measured using a pressure transducer (Honeywell, NC, USA). The Chi-square, one-way ANOVA, Kruskal-Wallis, and Mann-Whitney U tests were employed depending on the type and distribution of data.

Results A total of 102 replicates were performed, 34 for each technique. The triple aspiration technique provided a significantly higher rate of FPE than the syringe and pump aspiration techniques (67.6% (23/34) vs. 41.1% (14/34) and 41.1% (14/34), respectively, p= 0.02). Additionally, the triple aspiration technique achieved final mTICI 2c/3 recanalization with a significantly lower number of thrombectomy attempts compared to single syringe aspiration (1.2 ± 0.5 vs. 1.8 ± 0.8, p=0.005). The triple aspiration technique generated significantly higher vacuum pressure than both the single syringe and vacuum pump aspiration (28.3 ± 0.2 vs. 27.2 ± 0.3 (p= 0.002) and 26.2 ± 0.4 (p=0.001), respectively). The differences in final mTICI 2c/3 rates and distal embolization parameters were not statistically significantly different across the groups.

Conclusion Our findings suggest that a triple aspiration technique can improve FPE rates and vacuum pressure in aspiration thrombectomy. Further studies are needed to examine the safety and efficacy of triple aspiration in the clinical setting.

Disclosures C. Bilgin: None. J. Li: None. E. Bayraktar: None. R. Naylor: None. A. Oliver: None. Y. Ueki: None. J. Cortese: None. L. Rinaldo: None. R. Kadirvel: None. W. Brinjikji: None. H. Cloft: None. D. Kallmes: None.

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