S Soize1,2, L Pierot3, M Mirza4, G Gunning4, M Gilvarry4, M Gawlitza3, D Vivien2, M Zuber5, E Touzé2. 1. From the Department of Neuroradiology (S.S., L.P., M. Gawlitza), Hôpital Maison Blanche, Champagne-Ardenne University, Reims, France ssoize@chu-reims.fr. 2. Unité Mixte de Recherche (UMR)-S 1237 Physiopathology and Imaging of Neurological Disorders (S.S., D.V., E.T.), National Institute for Health and Medical Research, Normandie University, Université Caen Normandie, Cyceron, Caen, France. 3. From the Department of Neuroradiology (S.S., L.P., M. Gawlitza), Hôpital Maison Blanche, Champagne-Ardenne University, Reims, France. 4. Neuravi/Cerenovus (M.M., G.G., M. Gilvarry), Galway, Ireland. 5. Department of Neurology (M.Z.), Hôpital Saint-Joseph, Paris Descartes University, Paris, France.
Abstract
BACKGROUND AND PURPOSE: About 20% of patients with acute ischemic stroke due to large-artery occlusion do not achieve recanalization with mechanical thrombectomy. We aimed to determine whether the speed of retrieval of the stent retriever influences the efficacy in removing different clot types. MATERIALS AND METHODS: Sixty mechanical thrombectomies were performed using an in vitro pulsatile cerebrovascular circulation model with controlled pressure and flow rate. Experiments were dichotomized into fast and slow retrieval using a wedging technique, in which the stent retriever and distal catheter are retrieved together. We used 3 different clot types: erythrocyte-rich, fibrin-rich, and friable clots. Primary end points were complete (TICI 3) and successful (TICI 2b-3) recanalizations. Secondary measures were distal and new territory embolizations. RESULTS: Fast retrieval was more frequently associated with complete (RR = 1.83; 95% CI, 1.12-2.99) and successful recanalization (RR = 1.50; 95% CI, 1.03-2.19) than slow retrieval, without a difference in distal embolization (RR = 0.75; 95% CI, 0.29-1.90). There were no emboli in a new territory. The advantage of fast retrieval over slow retrieval differed according to the clot composition, with a stronger effect with fibrin-rich clots with regard to complete (RR = 4.00; 95% CI, 1.11-14.35; Pint = .04) and successful (Pint = .10) recanalization. CONCLUSIONS: In our experimental model, a fast removal improved recanalization rates of mechanical thrombectomy, especially in the case of fibrin-rich clots. An in vivo confirmation is warranted to see whether our findings can have an impact in clinical practice.
BACKGROUND AND PURPOSE: About 20% of patients with acute ischemic stroke due to large-artery occlusion do not achieve recanalization with mechanical thrombectomy. We aimed to determine whether the speed of retrieval of the stent retriever influences the efficacy in removing different clot types. MATERIALS AND METHODS: Sixty mechanical thrombectomies were performed using an in vitro pulsatile cerebrovascular circulation model with controlled pressure and flow rate. Experiments were dichotomized into fast and slow retrieval using a wedging technique, in which the stent retriever and distal catheter are retrieved together. We used 3 different clot types: erythrocyte-rich, fibrin-rich, and friable clots. Primary end points were complete (TICI 3) and successful (TICI 2b-3) recanalizations. Secondary measures were distal and new territory embolizations. RESULTS: Fast retrieval was more frequently associated with complete (RR = 1.83; 95% CI, 1.12-2.99) and successful recanalization (RR = 1.50; 95% CI, 1.03-2.19) than slow retrieval, without a difference in distal embolization (RR = 0.75; 95% CI, 0.29-1.90). There were no emboli in a new territory. The advantage of fast retrieval over slow retrieval differed according to the clot composition, with a stronger effect with fibrin-rich clots with regard to complete (RR = 4.00; 95% CI, 1.11-14.35; Pint = .04) and successful (Pint = .10) recanalization. CONCLUSIONS: In our experimental model, a fast removal improved recanalization rates of mechanical thrombectomy, especially in the case of fibrin-rich clots. An in vivo confirmation is warranted to see whether our findings can have an impact in clinical practice.
Authors: Volker Maus; Daniel Behme; Christoph Kabbasch; Jan Borggrefe; Ioannis Tsogkas; Omid Nikoubashman; Martin Wiesmann; Michael Knauth; Anastasios Mpotsaris; Marios Nikos Psychogios Journal: Clin Neuroradiol Date: 2017-02-13 Impact factor: 3.649
Authors: Waleed Brinjikji; Sharon Duffy; Anthony Burrows; Werner Hacke; David Liebeskind; Charles B L M Majoie; Diederik W J Dippel; Adnan H Siddiqui; Pooja Khatri; Blaise Baxter; Raul Nogeuira; Matt Gounis; Tudor Jovin; David F Kallmes Journal: J Neurointerv Surg Date: 2016-05-10 Impact factor: 5.836
Authors: Francesco Massari; Nils Henninger; Juan Diego Lozano; Anand Patel; Anna Luisa Kuhn; Mary Howk; Mary Perras; Christopher Brooks; Matthew J Gounis; Peter Kan; Ajay K Wakhloo; Ajit S Puri Journal: Interv Neuroradiol Date: 2016-02-22 Impact factor: 1.610
Authors: Gillian M Gunning; Kevin McArdle; Mahmood Mirza; Sharon Duffy; Michael Gilvarry; Patrick A Brouwer Journal: J Neurointerv Surg Date: 2017-01-02 Impact factor: 5.836
Authors: Shaarada Srivatsa; Yifei Duan; John P Sheppard; Shivani Pahwa; Jonathan Pace; Xiaofei Zhou; Nicholas C Bambakidis Journal: J Neurosurg Date: 2020-01-24 Impact factor: 5.115
Authors: J Kaesmacher; J Gralla; P J Mosimann; F Zibold; M R Heldner; E Piechowiak; T Dobrocky; M Arnold; U Fischer; P Mordasini Journal: AJNR Am J Neuroradiol Date: 2018-08-30 Impact factor: 3.825
Authors: Kajo van der Marel; Ju-Yu Chueh; Olivia W Brooks; Robert M King; Miklos G Marosfoi; Erin T Langan; Sarena L Carniato; Matthew J Gounis; Raul G Nogueira; Ajit S Puri Journal: J Neurointerv Surg Date: 2016-02-01 Impact factor: 5.836
Authors: Helena Guerreiro; Nadine Wortmann; Thomas Andersek; Tuan N Ngo; Andreas M Frölich; Dieter Krause; Jens Fiehler; Anna A Kyselyova; Fabian Flottmann Journal: PLoS One Date: 2022-09-09 Impact factor: 3.752