Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland
Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland.
J Neurointerv Surg. 2021 Dec;13(12):1152-1156. doi: 10.1136/neurintsurg-2020-016889. Epub 2021 Jan 22.
Successful direct thromboaspiration (DTA) is related to several factors such as clot consistency, size, and location. It has also been demonstrated recently that the angle of interaction (AOI) formed by the aspiration catheter and the clot is related to DTA efficacy. The aims of this study were three-fold: (a) to confirm the clinical finding that the AOI formed by the aspiration catheter and the clot influence DTA efficacy; (b) to evaluate to what extent this influence varies according to differences in clot consistency and size; and (c) to validate stent retriever thrombectomy as an effective rescue treatment after DTA failure in the presence of an unfavorable AOI.
A rigid vascular phantom designed to reproduce a middle cerebral artery trifurcation anatomy with three M2 segments forming different angles with M1 and thrombus analog of different consistencies and sizes was used.
DTA was highly effective for AOIs >125.5°, irrespective of thrombus analog features. However, its efficacy decreased for acute AOIs. Rescue stent retriever thrombectomy was effective in 92.6% of cases of DTA failure.
This in vitro study confirmed that the AOI formed by the aspiration catheter and the thrombus analog influenced DTA efficacy, with an AOI >125.5° related to an effective DTA. Stent retriever thrombectomy was an effective rescue treatment after DTA failure, even in the presence of an unfavorable AOI.
成功的直接血栓抽吸（DTA）与血栓的一致性、大小和位置等多个因素有关。最近还表明，抽吸导管与血栓形成的相互作用角度（AOI）与 DTA 疗效有关。本研究的目的有三个：（a）证实临床发现抽吸导管和血栓形成的 AOI 影响 DTA 疗效；（b）评估根据血栓一致性和大小的差异，这种影响的程度；（c）验证支架取栓术作为 DTA 失败后存在不利 AOI 时的有效挽救治疗。
使用刚性血管模拟体，该模拟体旨在再现大脑中动脉三叉解剖结构，其中三个 M2 段与 M1 形成不同角度，并形成不同一致性和大小的血栓模拟物。
无论血栓模拟物的特征如何，对于 AOI>125.5°，DTA 的效果均很高。然而，对于急性 AOI，其效果降低。在 DTA 失败的情况下，支架取栓术的挽救成功率为 92.6%。
这项体外研究证实，抽吸导管和血栓模拟物形成的 AOI 影响 DTA 的疗效，AOI>125.5°与有效的 DTA 相关。即使存在不利的 AOI，支架取栓术也是 DTA 失败后的有效挽救治疗。
