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Original research
Hydrodynamic comparison of the Penumbra system and commonly available syringes in forced-suction thrombectomy
  1. Scott Douglas Simon1,
  2. Casey Paul Grey2
  1. 1VCU Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
  2. 2VCU Biomedical Engineering, Graduate School, Virginia Commonwealth University, Richmond, Virginia, USA
  1. Correspondence to Dr Scott Simon, VCU Department of Neurosurgery, Virginia Commonwealth University, 417 North 11th Street, Sixth Floor, Richmond, VA 23298, USA; ssimon3{at}


Background The Penumbra system uses a coaxial separator and continuous extracorporeal suction to remove a clot from a cerebral artery. Forced-suction thrombectomy (FST) involves aspirating clots through the same reperfusion catheter using only a syringe, decreasing the procedure time and supplies needed.

Objective To evaluate multiple combinations of catheters and syringes to determine the optimal pairing for use in FST.

Methods Tests were performed using both the Penumbra system and syringes to aspirate water through Penumbra 0.041 inch (041), 4Max, 0.054 inch (054) and 5Max reperfusion catheters and a shuttle sheath. Dynamic pressure and flow at the catheter tip were calculated from the fill times for each system. Static pressure and force for each aspiration source were determined with a vacuum gauge.

Results All syringes provided significantly higher dynamic pressure at the catheter tip than the Penumbra system (p<0.001). Increasing syringe volume significantly increased static pressure (p<0.001). Both flow and aspiration force significantly increased with catheter size (p<0.001). Cases are presented to demonstrate the clinical value of the laboratory principles.

Conclusions Maximizing static and dynamic pressure when performing FST is achieved by aspirating with a syringe possessing both the largest volume and the largest inlet diameter available. Maximizing aspiration force and flow rate is achieved by using the largest catheter possible.

  • Catheter
  • Thrombectomy
  • Intervention
  • Stroke
  • Technique

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