Quantitative Characterization of Recanalization and Distal Emboli with a Novel Thrombectomy Device
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LABORATORY INVESTIGATION
STROKE/NEUROINTERVENTIONS
Quantitative Characterization of Recanalization and Distal Emboli with a Novel Thrombectomy Device Ju-Yu Chueh1 • Miklos G. Marosfoi1 • Vania Anagnostakou1 • Rose A. Arslanian1 Michael P. Marks2 • Matthew J Gounis1
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Received: 26 June 2020 / Accepted: 7 October 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Purpose The first-pass effect during mechanical thrombectomy improves clinical outcomes regardless of first-line treatment approach, but current success rates for complete clot capture with one attempt are still less than 40%. We hypothesize that the ThrombX retriever (ThrombX Medical Inc.) can better engage challenging clot models during retrieval throughout tortuous vasculature in comparison with a standard stent retriever without increasing distal emboli. Materials and Methods Thrombectomy testing with the new retriever as compared to the Solitaire stent retriever was simulated in a vascular replica with hard and soft clot analogs to create a challenging occlusive burden. Parameters included analysis of distal emboli generated per clot type, along with the degree of recanalization (complete, partial or none) by retrieval device verified by angiography. Results The ThrombX device exhibited significantly higher rates of first-pass efficacy (90%) during hard clot retrieval in comparison with the control device (20%) (p \ 0.009), while use of both techniques during soft clot retrieval resulted in equivalent recanalization. The soft clot model generated higher numbers of large emboli ([200 lm) across both device groups (p = 0.0147), and no
& Matthew J Gounis [email protected] 1
Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, 55 Lake Ave N, SA-107R, Worcester, MA 01655, USA
2
Department of Radiology, Stanford University School of Medicine, 730 Welch Rd 1st Fl, Palo Alto, CA 94304, USA
significant differences in numbers of distal emboli were noted between the ThrombX and Solitaire techniques. Conclusions Irrespective of clot composition, use of the ThrombX retriever demonstrated high rates of complete recanalization at first pass in comparison with a state-ofthe-art stent retriever and proved to be superior in the hard clot model. Preliminary data suggest that risk of distal embolization associated with the ThrombX system is comparable to that of the control device. Keywords Acute ischemic stroke Mechanical thrombectomy In vitro model
Introduction Advancements in endovascular treatment options have significantly improved functional outcome of patients suffering from acute ischemic stroke (AIS) due to a large vessel occlusion. However, consistent rates of successful recanalization may be compromised by the inability of most thrombectomy devices to completely remove the clot with one attempt. First-pass effect (FPE) is defined as achieving a complete (TICI 3) or near comp
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