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Original research
Trackability of distal access catheters: an in vitro quantitative evaluation of navigation strategies
  1. Jiahui Li1,2,
  2. Alejandro Tomasello3,
  3. Manuel Requena1,3,
  4. Pere Canals1,4,
  5. Riccardo Tiberi1,5,
  6. Iñaki Galve6,
  7. Elisabeth Engel5,7,
  8. David F Kallmes8,
  9. Oscar Castaño9,10,
  10. Marc Ribo1,2
  1. 1Stroke Unit, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
  2. 2Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Catalunya, Spain
  3. 3Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
  4. 4Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
  5. 5Materials Science and Engineering, Universitat Politecnica de Catalunya, Barcelona, Catalunya, Spain
  6. 6Department of Research and Development, Anaconda Biomed, Barcelona, Spain
  7. 7CIBER en Bioingeniería, Biomateriales y Nanomedicina, CIBER, Madrid, Comunidad de Madrid, Spain
  8. 8Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  9. 9Electronics and Biomedical Engineering, University of Barcelona, Barcelona, Catalunya, Spain
  10. 10Biomaterials for Regenerative Therapies, Institute for Bioengineering in Catalonia, Barcelona, Catalunya, Spain
  1. Correspondence to Dr Marc Ribo, Stroke Unit. Neurology, Hospital Vall d'Hebron, Barcelona, Spain; marcriboj{at}hotmail.com

Abstract

Background In mechanical thrombectomy (MT), distal access catheters (DACs) are tracked through the vascular anatomy to reach the occlusion site. The inability of DACs to reach the occlusion site has been reported as a predictor of unsuccessful recanalization. This study aims to provide insight into how to navigate devices through the vascular anatomy with minimal track forces, since higher forces may imply more risk of vascular injuries.

Methods We designed an experimental setup to monitor DAC track forces when navigating through an in vitro anatomical model. Experiments were recorded to study mechanical behaviors such as tension buildup against vessel walls, DAC buckling, and abrupt advancements. A multiple regression analysis was performed to predict track forces from the catheters’ design specifications.

Results DACs were successfully delivered to the target M1 in 60 of 63 in vitro experiments (95.2%). Compared to navigation with unsupported DAC, the concomitant coaxial use of a microcatheter/microguidewire and microcatheter/stent retriever anchoring significantly reduced the track forces by about 63% and 77%, respectively (p<0.01). The presence of the braid pattern in the reinforcement significantly reduced the track forces regardless of the technique used (p<0.05). Combined coil and braid reinforcement configuration, as compared with coil alone, and a thinner distal wall were predictors of lower track force when navigating with unsupported DAC.

Conclusions The use of microcatheter and stent retriever facilitate smooth navigation of DACs through the vascular tortuosity to reach the occlusion site, which in turn improves the reliability of tracking when positioning the DAC closer to the thrombus interface.

  • Stroke
  • Thrombectomy
  • Catheter
  • Navigation
  • Vessel Wall

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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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 JL, MRi, AT, and OC conceived of the study and experimental setup design. JL, PC, and RT performed the experiments and statistical analyses. MRi and MRe reported the clinical case. JL and MRi drafted the manuscript. The article was critically revised by JL, MRi, MRe, DFK, IG, OC, and EE. All authors approved the final version of the manuscript. MRi is the guarantor of the article.

  • Funding This work was funded by the European Regional Development Fund (FEDER), the Spanish Ministry of Science and Innovation (MICINN), and the State Research Agency (AEI) with the Projects (RTI2018-096320-B-C21, and RTI2018-097038-B-C22), the European Commission-Euronanomed nAngioderm Project (JTC2018-103) funded through the Spanish Ministry of Science and Innovation (ref. PCI2019-103648), the Spanish network of cell therapy (TERCEL), the Programme/Generalitat de Catalunya (2017-SGR-359) and the Severo Ochoa Programme of the Spanish Ministry of Science and Innovation (MICINN—Grant SEV-2014–0425, 2015–2019 and CEX2018-000789-S, 2019–2023).

  • Competing interests MRi reports ownership of Anaconda Biomed, and Methinks shares, personal fees from Apta Targets, Medtronic, Stryker, Cerenovus, Philips, and Balt. AT reports receiving personal fees from Anaconda Biomed, Balt, Medtronic, Perflow, and Stryker. DFK reports royalty payments from Medtronic, ownership of Conway Medical, LLS; Marblehead Medical, LLC; Superior Medical Experts, LLC; Nested Knowledge, LLC, research support from Medtronic, MicroVention, Stryker, Balt, Insera Therapeutics, and Cerenovus. IG reports ownership of Anaconda Biomed shares and he is currently an employee of Anaconda Biomed. The other authors have no conflicts of interest to declare that are relevant to the content of this article.

  • 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.