Microcatheter navigation through the clot: does size matter
Department of Radiology; New England Center for Stroke Research
Cardiovascular Diseases | Equipment and Supplies | Nervous System Diseases | Neurology | Radiology | Surgery
BACKGROUND: Despite high recanalization rates achieved with endovascular treatment of acute ischemic strokes, around 50% of eligible patients will not achieve a good outcome. Parameters that may determine patient outcomes include: time from puncture to recanalization, the collateral status, the anesthesia regimen, blood pressure management, and distal emboli. Characterization of distal emboli generated during mechanical thrombectomy has been performed in previous studies.
OBJECTIVE: To further investigate the risk of distal embolization associated with microcatheter navigation across the clot.
METHODS: A contrast-enhanced clot analog was used in an in vitro model that mimicked a middle cerebral artery occlusion within a complete circle of Willis vascular replica. The clot was crossed with one of the following microcatheters: Pro18, XT-27 or 3MAX. The emboli generated during the procedure were collected and measured.
RESULTS: The use of Pro18 and XT-27 resulted in a significant reduction of visible particles (size > /=500 microm) as compared with the 3MAX catheter (P < 0.003). For the size range between 8 and 200 microm, there was a trend for Pro18 to generate fewer particles (-18%) than XT-27 but without statistical significance (P > 0.05). In comparison with previously published data, acquired under the same conditions, it was found that the clot crossing maneuver accounts approximately for 12% of the total number of small emboli ( < 200 microm) induced during a stent retriever-mediated mechanical thrombectomy procedure via a balloon guide catheter.
CONCLUSIONS: The clot crossing maneuver has a significant effect on the total number of small particles induced during mechanical thrombectomy. Smaller microcatheter sizes should be favored when possible.
catheter, device, stroke
DOI of Published Version
J Neurointerv Surg. 2018 Sep 3. pii: neurintsurg-2018-014105. doi: 10.1136/neurintsurg-2018-014105. [Epub ahead of print]. Link to article on publisher's site
Journal of neurointerventional surgery
Caroff, Jildaz; King, Robert M.; Arslanian, Rose; Marosfoi, Miklos G.; Langan, Erin T.; Gounis, Matthew J.; and Chueh, Juyu, "Microcatheter navigation through the clot: does size matter" (2018). Radiology Publications and Presentations. 424.