PT - JOURNAL ARTICLE AU - Fernandez-Sanchez, David AU - Garcia-Sabido, Daniel AU - Jovin, Tudor G AU - Villanova, Helena AU - Andersson, Tommy AU - Nogueira, Raul G AU - Cognard, Cristophe AU - Ribo, Marc AU - Siddiqui, Adnan H AU - Galve, Iñaki AU - Arad, Ofir AU - Salmon, François TI - Suction force rather than aspiration flow correlates with recanalization in hard clots: an in vitro study model AID - 10.1136/neurintsurg-2020-017242 DP - 2021 Dec 01 TA - Journal of NeuroInterventional Surgery PG - 1157--1161 VI - 13 IP - 12 4099 - http://jnis.bmj.com/content/13/12/1157.short 4100 - http://jnis.bmj.com/content/13/12/1157.full SO - J NeuroIntervent Surg2021 Dec 01; 13 AB - Background ANA Advanced Neurovascular Access provides a novel funnel component designed to reduce clot fragmentation and facilitate retrieval in combination with stent-retrievers (SRs) in stroke patients by restricting flow and limiting clot shaving. In previous publications ANA presented excellent in vitro/in vivo efficacy data, especially with fibrin-rich hard clots. We aimed to determine the main physical property responsible for these results, namely suction force versus aspiration flow.Methods We evaluated in a bench model the suction force and flow generated by ANA and compared them to other neurovascular catheters combined with a SR (Solitaire). Aspiration flow was evaluated with a flow rate sensor while applying vacuum pressure with a pump. Suction force was determined using a tensile strength testing machine and a purposely designed tool that completely seals the device tip simulating complete occlusion by a hard clot. Suction force was defined as the force needed to separate the device from the clot under aspiration. All experiments were repeated five times, and mean values used for comparisons.Results Aspiration flow increased with the inner diameter of the device: ANA 1.85±0.04 mL/s, ACE68 3.74±0.05 mL/s, and 8F-Flowgate2 5.96±0.30 mL/s (P<0.001). After introducing the SR, the flow was reduced by an average of 0.57±0.12 mL/s. Due to its larger distal surface, ANA suction force (1.69±0.40 N) was significantly higher than ACE68 (0.26±0.04 N) and 8F-Flowgate2 (0.42±0.06 N) (P<0.001). After introducing the SR, suction force variation was not relevant except for ANA that increased to 2.64±0.41 N.Conclusion Despite lower in vitro aspiration flow, the ANA design showed a substantially higher suction force than other thrombectomy devices.All data are available upon reasonable request to the corresponding author: https://orcid.org/0000-0001-9242-043X