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, Puri Ajit S
Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Department of Preclinical Science, Stryker Neurovascular, Fremont, California, USA.
J Neurointerv Surg. 2016 Dec;8(12):1278-1282. doi: 10.1136/neurintsurg-2015-012209. Epub 2016 Feb 1.
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.
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).
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).
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.
血管内取栓术实现紧急大血管闭塞的快速血管再通已被证明具有临床益处。我们试图测量器械与血栓的相互作用，将其作为有效取栓的一种潜在机制。
在患者特异性血管模型中注入两种不同的不透射线血栓模型，以造成大脑中动脉闭塞。通过将器械出鞘或先出鞘再推挤器械的方式（每组n = 8），将不透射线的支架取栓器部署在血栓内。器械部署后立即进行高分辨率锥形束CT检查，并在5分钟后重复检查。创建了一个图像处理流程，以定量评估与支架结合的血栓体积，称为血栓整合因子（CIF）。
当器械与硬血栓接触时，两种部署方式的CIF有显著差异（p = 0.041），但与软血栓接触时无显著差异（p = 0.764）。在硬血栓中，使用推挤技术时，部署后与最终成像数据集之间的CIF显著增加（p = 0.019），而使用出鞘技术时则无显著增加（p = 0.067）。当我们在不考虑技术的情况下研究不同血栓模型中时间对CIF的影响时，两个血栓模型的最终数据集中CIF相对于部署后数据集均显著增加（p = 0.004 - 0.007）。
本研究在体外系统中证明了在硬血栓中输送器械时推挤Trevo支架以增强整合的益处。无论输送技术如何，等待5分钟后，两种血栓模型中的血栓与器械整合均增加。
