Influence of Thrombus Composition on Thrombectomy: ADAPT vs. Balloon Guide Catheter and Stent Retriever in a Flow Model
Influence of Thrombus Composition on Thrombectomy: ADAPT vs. Balloon Guide Catheter and Stent Retriever in a Flow Model
复制标题
DOI：
10.1055/a-0998-4246
复制
发表时间：
2020-03-01
影响因子：
1.8
通讯作者：
Jansen, Olav
中科院分区：
文献类型：
--
作者：
Madjidyar, Jawid;Vidal, Lorena Pineda;Jansen, Olav
y目的首次通过直接抽吸技术和使用球囊导引导管回收支架代表了先进的血栓切除术技术，这些技术越来越多地用于临床常规。本实验研究的目的是评估技术的有效性是否取决于凝块的组成和可视化的设备和凝块之间的相互作用。材料和方法将富含红细胞（红色）和富含纤维蛋白（白色）的凝块放置到大脑中动脉的M1段中的透明血管体模的生理结构。使用程控泵维持生理血流动力学条件。一方面使用5 F抽吸导管（ADAPT）进行直接抽吸，另一方面使用球囊导引导管进行支架回收（血流停止/逆转）。在直接目视控制下进行实验，以观察器械与凝块之间的相互作用。主要终点为通过/操作次数以及远端栓塞和新区域（大脑前动脉）中栓塞的发生率，直至实现完全再通。实验采用全高清摄像机拍摄，以识别栓子。结果每种技术和凝块模型进行了6次实验。通过ADAPT回收红色凝块，通过次数和远端栓塞较少，通常可在闭塞部位直接抽吸。在每次实验中，白色凝块堵塞了5 F抽吸导管的头端。必须将导管拉回颈部颈内动脉的长鞘管中，产生远端栓塞。支架取栓器和球囊导引导管取出了白色凝块，远端栓塞较少。通过次数无差异。在两种凝块模型中，支架-血栓相互作用均为浅表性。通过血流停止和近端抽吸/血流反向成功回收。一个栓塞在一个新的领域时，使用每种技术在白色clots.Conclusion本实验研究表明，先进的血栓切除术技术的疗效可能取决于凝块成分。为正确的血栓确定正确的技术可能会改善血栓切除术的结果。在临床环境中，非增强CT中的血栓形态可用作患者选择的标记。
y Purpose A first-pass, direct aspiration technique and stent retrieval with a balloon guide catheter represent advanced thrombectomy techniques that are increasingly being used in the clinical routine. The purpose of this experimental study was to evaluate whether the techniques' effectiveness depended on the clot composition and to visualize the interaction between the devices and the clot.Materials and Methods Erythrocyte-rich (red) and fibrin-rich (white) clots were placed into the M1-segment of the middle cerebral artery in a transparent vascular phantom with physiological architecture. Physiological hemodynamic conditions were maintained with a programmable pump. On the one hand direct aspiration with a 5F aspiration catheter (ADAPT) and on the other hand stent retrieval with a balloon guide catheter (flow arrest/reversal) was performed. The experiments were made under direct visual control to observe the interaction between the devices and the clot. The primary end points were the number of passes/maneuvers and the occurrence of distal emboli and emboli in a new territory (anterior cerebral artery), until full recanalization was achieved. The experiment was filmed with a full high-definition camera identifying emboli.Results Six experiments were conducted for each technique and clot model. Red clots were retrieved by ADAPT with fewer passes and distal emboli, and could usually be aspirated directly at the occlusion site. White clots clogged the tip of the 5F aspiration catheter in every experiment. The catheter had to be pulled back into the long sheath in the cervical internal carotid artery, producing distal emboli. White clots were retrieved by the stent retriever and balloon guide catheter with fewer distal emboli. There was no difference in the number of passes. The stent-thrombus interaction was superficial in both clot models. Successful retrieval was granted by the flow arrest and proximal aspiration/flow reversal. One embolus in a new territory developed when using each technique in white clots.Conclusion This experimental study showed that the efficacy of advanced thrombectomy techniques might depend on clot composition. Identifying the right technique for the right clot might improve the results of thrombectomy. In a clinical setting the thrombus morphology in non-enhanced CT could be used as a marker for patient selection.