Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
Chemical and Biomolecular Engineering Department, University of California, Los Angeles, USA.
Interv Neuroradiol. 2022 Feb;28(1):43-49. doi: 10.1177/15910199211015060. Epub 2021 May 5.
Fragile soft clots and stiff clots remain challenging in the treatment of acute ischemic stroke. This study aims to investigate the impact of clot stiffness on the efficacy of thrombectomy devices and a new aspiration catheter with a hydro-separator.
The Neurostar aspiration catheter has a novel hydro-separator technology that macerates clots by a stream of saline inside the catheter. The Neurostar catheter and two commercially available devices, the SOFIA aspiration catheter and Solitaire stent retriever, were tested in this study. We evaluated the efficacy of each device on clots with various stiffness in a simple in vitro model. We also assessed single-pass recanalization performance in challenging situations with large erythrocyte-rich clots and fibrin-rich clots in a realistic vascular model.
We observed an inverse association between the clot stiffness and recanalization rates. The aspiration catheter, SOFIA ingested soft clots but not moderately stiff clots. When removing soft clots with the stent retriever, fragmentation was observed, although relatively stiff clots were well-integrated and removed. The Neurostar ingested soft clots similar to the aspiration catheter, and also aspirated stiff clots by continuous suction with hydro-separator. In the experiments with challenging clots, the Neurostar led to significantly higher recanalization rates than the stent retriever and aspiration catheter.
The stiffness of the clots affected the efficacy of endovascular thrombectomy based on the type of device. The Neurostar catheter with hydro-separator resulted in better success rates than a commercially available aspiration catheter and stent retriever in this experimental model.
在急性缺血性脑卒中的治疗中，脆弱的软血栓和硬血栓仍然是一个挑战。本研究旨在探讨血栓硬度对血栓切除术器械和具有水力分离器的新型抽吸导管疗效的影响。
Neurostar 抽吸导管具有一种新颖的水力分离器技术，通过导管内的盐水流将血栓粉碎。本研究测试了 Neurostar 导管和两种市售设备，SOFIA 抽吸导管和 Solitaire 支架取栓器。我们在简单的体外模型中评估了每种设备对不同硬度血栓的疗效。我们还在具有大红细胞丰富血栓和富含纤维蛋白血栓的现实血管模型中评估了在具有挑战性的情况下的单次通过再通性能。
我们观察到血栓硬度与再通率之间存在反比关系。抽吸导管 SOFIA 摄取软血栓，但不摄取中度硬血栓。当用支架取栓器取出软血栓时，会观察到血栓碎片，但相对硬的血栓会被很好地整合并取出。Neurostar 类似于抽吸导管摄取软血栓，并且通过水力分离器的连续抽吸也抽吸硬血栓。在具有挑战性的血栓实验中，Neurostar 导致的再通率明显高于支架取栓器和抽吸导管。
血栓的硬度会影响基于器械类型的血管内血栓切除术的疗效。在这个实验模型中，具有水力分离器的 Neurostar 导管比市售的抽吸导管和支架取栓器具有更好的成功率。
