Abstract
Introduction
We report an in vitro study comparing the effectiveness of clot removal and clot fragmentation of five embolectomy systems.
Methods
A flow model was embolized with fresh and old thrombi, occluding an inner diameter of 2–5 mm simulating internal carotid artery (ICA), basilar artery (BA) and middle cerebral artery (MCA) branch occlusion. Embolectomy was performed using five retrieval systems: CATCH (Balt), Merci retriever (Concentric), InTime and Attracter (Boston Scientific), and the Phenox Clot Retriever (Phenox). Clot removal and evidence and type of thrombus fragmentation and distal embolization were recorded.
Results
There were no observable differences attributable to thrombus age. The Merci, CATCH and Phenox Clot Retriever were equally able to mobilize and remove thrombi with the exception of one particularly firm clot. There were marked differences in terms of thrombus fragmentation and distal embolization. All devices produced micro- and macrofragments during penetration and retrieval. The Phenox Clot Retriever was able to filter fragments. The InTime and Attracter devices failed to retrieve thrombi in this model and achieved partial removal at best with a tendency towards thrombus displacement and fragmentation.
Conclusion
Within limits, the experimental setup was appropriate for generating occlusions of diameter 2–5 mm of various lengths, simulating ICA, BA and MCA thromboembolism. In this model, thrombus mobilization appeared to be less dependent upon the individual design of the retrieval system than on thrombus fragmentation. The ability to prevent distal embolization is, however, strongly dependent on the ability of a thrombectomy device to capture fragments that are generated during removal of the device.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333(24):1581–1587
Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, Boysen G, Bluhmki E, Hoxter G, Mahagne MH (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 274(13):1017–1025
Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F (1999) Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 282(21):2003–2011
Del Zoppo GJ, Higashida RT, Furlan AJ (1998) PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. PROACT Investigators. Prolyse in Acute Cerebral Thromboembolism. Stroke 29:4–11
Alexandrov AV, Demchuk AM, Felberg RA, Christou I, Barber PA, Burgin WS, Malkoff M, Wojner AW, Grotta JC (2000) High rate of complete recanalization and dramatic clinical recovery during tPA infusion when continuously monitored with 2-MHz transcranial doppler monitoring. Stroke 31(3):610–614
Röther J, Schellinger PD, Gass A, Siebler M, Villringer A, Fiebach JB, Fiehler J, Jansen O, Kucinski T, Schoder V, Szabo K, Junge-Hulsing GJ, Hennerici M, Zeumer H, Sartor K, Weiller C, Hacke W, Kompetenznetzwerk Schlaganfall Study Group (2002) Effect of intravenous thrombolysis on MRI parameters and functional outcome in acute stroke <6 hours. Stroke 33(10):2438–2445
Leary MC, Saver JL, Gobin YP (2003) Beyond tissue plasminogen activator: mechanical intervention in acute stroke. Ann Emerg Med 41:838–846
Bergui M, Stura G, Daniele D, Cerrato P, Berardino M, Bradac GB (2006) Mechanical thrombolysis in ischemic stroke attributable to basilar artery occlusion as first-line treatment. Stroke 37(1):145–150
Chapot R (2005) First experience with the CATCH, a new device for cerebral thrombectomy. Interventional Neuroradiology 11 [Suppl 2]:56–58
Martinez H, Zoarski GH, Obuchowski AM, Stallmeyer B, Papangelou A, Airan-Javia S (2004) Mechanical thrombectomy of the internal carotid artery and middle cerebral artery by using the retriever device. AJNR Am J Neuroradiol 25:1812–1815
Zaidat OO, Tolbert M, Smith TP, Alexander M (2005) Primary endovascular therapy with clot retrieval and balloon angioplasty for acute basilar artery occlusion. Pediatr Neurosurg 41:323–327
Kirton A, Wong JH, Mah J, Ross BC, Kennedy J, Bell K, Hill MD (2003) Successful endovascular therapy for acute basilar thrombosis in an adolescent. Pediatrics 112:248–251
Noser EA, Shaltoni HM, Hall CE, Alexandrov AV, Garami Z, Cacayorin ED, Song JK, Grotta JC, Campbell MS 3rd (2005) Aggressive mechanical clot disruption: a safe adjunct to thrombolytic therapy in acute stroke? Stroke 36:292–296
Qureshi AI, Siddiqui AM, Suri MF, Kim SH, Ali Z, Yahia AM, Lopes DK, Boulos AS, Ringer AJ, Saad M, Guterman LR, Hopkins LN (2002) Aggressive mechanical clot disruption and low-dose intra-arterial third generation thrombolytic agent for ischemic stroke: a prospective study. Neurosurgery 51:1319–1329
Arnold M, Schroth G, Nedeltchev K (2002) Intra-arterial thrombolysis in 100 patients with acute stroke due to middle cerebral artery occlusion. Stroke 33:1828–1833
Mayer TE, Hamann GF, Schulte-Altedorneburg G, Bruckmann H (2005) Treatment of vertebrobasilar occlusion by using a coronary waterjet thrombectomy device: a pilot study. AJNR Am J Neuroradiol 26:1389–1394
Berlis A, Lutsep H, Barnwell S, Norbash A, Wechsler L, Jungreis CA, Woolfenden A, Redekop G, Hartmann M, Schumacher M (2005) Mechanical thrombolysis in acute ischemic stroke with endovascular photoacoustic recanalization. Stroke 35:1112–1116
Mahon BR, Nesbit GM, Barnwell SL (2003) North American clinical experience with the EKOS MicroLysUS infusion catheter for the treatment of embolic stroke. AJNR Am J Neuroradiol 24:534–538
Nakano S, Iseda T, Yoneyama T, Kawano H, Wakisaka S (2002) Direct percutaneous transluminal angioplasty for acute middle cerebral artery trunk occlusion: an alternative option to intra-arterial thrombolysis. Stroke 33:2872–2876
Henkes H, Miloslavski E, Lowens S, Reinartz J, Liebig T, Kuhne D (2005) Treatment of intracranial atherosclerotic stenosis with balloon dilatation and self-expanding stent deployment (Wing Span). Neuroradiology 47:222–228
Mazighi M, Tanasescu R, Ducrqc X, Vicut E, Bracard S, Houdart E, Woimant F (2006) Prospective study of symptomatic atherothrombotic intracranial stenoses: the GESICA study. Neurology 66(8):1187–1191
Eckert B, Kucinski T, Pfeifer G (2002) Endovascular therapy of acute vertebrobasilar occlusion: early treatment onset as the most important factor. Cerebrovasc Dis 14:42–50
Henkes H, Lowens S, Preiss H, Reinartz J, Miloslavski E, Kuhne D (2006) A new device for endovascular coil retrieval from intracranial vessels: alligator retrieval device. AJNR Am J Neuroradiol 27(2):327–329
Henkes H, Reinartz J, Lowens S, Miloslavski E, Roth C, Reith W, Kühne D (2006) A device for fast mechanical clot retrieval from intracranial arteries (Phenox clot retriever). Neurocrit Care 5(2):134–140
Conflict of interest statement
Ralf Hannes is an employee of Phenox GmbH. Elina Miloslavski is a consultant to Phenox GmbH. Hans Henkes is cofounder of Phenox GmbH and therefore has ownership interests.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Liebig, T., Reinartz, J., Hannes, R. et al. Comparative in vitro study of five mechanical embolectomy systems: effectiveness of clot removal and risk of distal embolization. Neuroradiology 50, 43–52 (2008). https://doi.org/10.1007/s00234-007-0297-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-007-0297-y