Quantitative assessment of device-clot interaction for stent retriever thrombectomy
Authors
van der Marel, KajoChueh, Ju-Yu
Brooks, Olivia W.
King, Robert M.
Marosfoi, Miklos G.
Langan, Erin T.
Carniato, Sarena L.
Gounis, Matthew J.
Nogueira, Raul G.
Puri, Ajit S.
UMass Chan Affiliations
Department of RadiologyDocument Type
Journal ArticlePublication Date
2016-02-01Keywords
CTStent
Stroke
Technique
Thrombectomy
Cardiovascular Diseases
Nervous System Diseases
Neurology
Radiology
Surgery
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PURPOSE: Rapid revascularization in emergent large vessel occlusion with endovascular embolectomy has proven clinical benefit. We sought to measure device-clot interaction as a potential mechanism for efficient embolectomy. METHODS: Two different radiopaque clot models were injected to create a middle cerebral artery occlusion in a patient-specific vascular phantom. A radiopaque stent retriever was deployed within the clot by unsheathing the device or a combination of unsheathing followed by pushing the device (n=8/group). High-resolution cone beam CT was performed immediately after device deployment and repeated after 5 min. An image processing pipeline was created to quantitatively evaluate the volume of clot that integrates with the stent, termed the clot integration factor (CIF). RESULTS: The CIF was significantly different for the two deployment variations when the device engaged the hard clot (p=0.041), but not the soft clot (p=0.764). In the hard clot, CIF increased significantly between post-deployment and final imaging datasets when using the pushing technique (p=0.019), but not when using the unsheathing technique (p=0.067). When we investigated the effect of time on CIF in the different clot models disregarding the technique, the CIF was significantly increased in the final dataset relative to the post-deployment dataset in both clot models (p=0.004-0.007). CONCLUSIONS: This study demonstrates in an in vitro system the benefit of pushing the Trevo stent during device delivery in hard clot to enhance integration. Regardless of delivery technique, clot-device integration increased in both clot models by waiting 5 min.Source
J Neurointerv Surg. 2016 Feb 1. pii: neurintsurg-2015-012209. doi: 10.1136/neurintsurg-2015-012209. [Epub ahead of print] Link to article on publisher's siteDOI
10.1136/neurintsurg-2015-012209Permanent Link to this Item
http://hdl.handle.net/20.500.14038/48031PubMed ID
26833539Related Resources
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This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:http://creativecommons.org/licenses/by-nc/4.0/Distribution License
http://creativecommons.org/licenses/by-nc/4.0/ae974a485f413a2113503eed53cd6c53
10.1136/neurintsurg-2015-012209
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Except where otherwise noted, this item's license is described as This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:<a href="http://creativecommons.org/licenses/by-nc/4.0/">http://creativecommons.org/licenses/by-nc/4.0/</a>