Department of Radiology
Cardiovascular Diseases | Nervous System Diseases | Neurology | Radiology | Surgery
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.
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Citation: 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 site
CT, Stent, Stroke, Technique, Thrombectomy
van der Marel, Kajo; Chueh, Ju-Yu; Brooks, Olivia W.; King, Robert M.; Marosfoi, Miklos G.; Langan, Erin T.; Carniato, Sarena L.; Gounis, Matthew J.; Nogueira, Raul G.; and Puri, Ajit S., "Quantitative assessment of device-clot interaction for stent retriever thrombectomy" (2016). Radiology Publications and Presentations. 138.
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