RT Journal Article
SR Electronic
T1 Quantitative assessment of device–clot interaction for stent retriever thrombectomy
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 1278
OP 1282
DO 10.1136/neurintsurg-2015-012209
VO 8
IS 12
A1 Kajo van der Marel
A1 Ju-Yu Chueh
A1 Olivia W Brooks
A1 Robert M King
A1 Miklos G Marosfoi
A1 Erin T Langan
A1 Sarena L Carniato
A1 Matthew J Gounis
A1 Raul G Nogueira
A1 Ajit S Puri
YR 2016
UL http://jnis.bmj.com/content/8/12/1278.abstract
AB Purpose Rapid revascularization in emergent large vessel occlusion with endovascular embolectomy has proven clinical benefit. We sought to measure device–clot interaction as a potential mechanism for efficient embolectomy.Methods Two different radiopaque clot models were injected to create a middle cerebral artery occlusion in a patient-specific vascular phantom. A radiopaque stent retriever was deployed within the clot by unsheathing the device or a combination of unsheathing followed by pushing the device (n=8/group). High-resolution cone beam CT was performed immediately after device deployment and repeated after 5 min. An image processing pipeline was created to quantitatively evaluate the volume of clot that integrates with the stent, termed the clot integration factor (CIF).Results The CIF was significantly different for the two deployment variations when the device engaged the hard clot (p=0.041), but not the soft clot (p=0.764). In the hard clot, CIF increased significantly between post-deployment and final imaging datasets when using the pushing technique (p=0.019), but not when using the unsheathing technique (p=0.067). When we investigated the effect of time on CIF in the different clot models disregarding the technique, the CIF was significantly increased in the final dataset relative to the post-deployment dataset in both clot models (p=0.004–0.007).Conclusions This study demonstrates in an in vitro system the benefit of pushing the Trevo stent during device delivery in hard clot to enhance integration. Regardless of delivery technique, clot–device integration increased in both clot models by waiting 5 min.