Department of Radiology, New England Center for Stroke Research, Division of Neuroimaging and Intervention, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Hôpital Beaujon, Department of Interventional Neuroradiology, Clichy, France.
J Neurointerv Surg. 2019 Sep;11(9):931-936. doi: 10.1136/neurintsurg-2018-014625. Epub 2019 Feb 4.
Evidence is mounting that first-pass complete recanalization during mechanical thrombectomy is associated with better clinical outcomes in patients presenting with an emergent large vessel occlusion. We hypothesize that aspiration achieving complete clot ingestion results in higher first-pass successful recanalization with quantitative reduction in distal emboli.
A patient-specific cerebrovascular replica was connected to a flow loop. Occlusion of the middle cerebral artery was achieved with clot analogs. Independent variables were the diameter of the aspiration catheter (0.054-0.088in) and aspiration pattern (static versus cyclical). Outcome measures were the first-pass rates of complete clot ingestion, the extent of recanalization, and the particle-size distribution of distal emboli.
All aspiration catheters were successfully navigated to the occlusion. Complete clot ingestion during aspiration thrombectomy resulted in first-pass complete recanalization in every experiment, only achieved in 21% of experiments with partial ingestion (P<0.0001). Aspiration through the large bore 0.088in device resulted in the highest rates of complete clot ingestion (90%). Cyclical aspiration (18-29 inHg, 0.5 Hz) significantly increased the rate of complete clot ingestion (OR21 [1.6, 266]; P=0.04). In all experiments, complete clot ingestion resulted in fewer and smaller distal emboli.
Complete clot ingestion results in fewer distal emboli and the highest rates of first-pass complete recanalization. The rate of complete ingestion during aspiration thrombectomy is a function of both the inner diameter of the aspiration catheter and use of cyclical aspiration.
越来越多的证据表明，在机械取栓过程中首次实现完全再通与急诊大血管闭塞患者的更好临床结局相关。我们假设抽吸实现完全血栓摄入会导致更高的首次通过成功再通，并减少远端栓塞的定量减少。
将患者特定的脑血管模型连接到流动回路。使用血栓模拟物实现大脑中动脉闭塞。自变量为抽吸导管的直径（0.054-0.088 英寸）和抽吸模式（静态与循环）。观察指标为首次通过完全血栓摄入率、再通程度和远端栓塞的粒径分布。
所有抽吸导管都成功到达闭塞部位。抽吸血栓切除术中的完全血栓摄入导致每次实验中的首次通过完全再通，仅在部分摄入的 21%实验中实现（P<0.0001）。使用大口径 0.088 英寸器械抽吸可实现最高的完全血栓摄入率（90%）。循环抽吸（18-29 英寸汞柱，0.5 Hz）显著增加了完全血栓摄入率（OR21 [1.6，266]；P=0.04）。在所有实验中，完全血栓摄入导致的远端栓塞更少且更小。
完全血栓摄入导致更少的远端栓塞和最高的首次通过完全再通率。抽吸血栓切除术中完全摄入的速率是抽吸导管的内径和使用循环抽吸的函数。
