Ohshima Tomotaka, Miyachi Shigeru
Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi, Japan.
Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi, Japan.
Asian J Neurosurg. 2021 Feb 23;16(1):84-88. doi: 10.4103/ajns.AJNS_237_20. eCollection 2021 Jan-Mar.
This study was conducted to evaluate various devices and techniques for endovascular thrombectomy that can reduce the risk of intraprocedural distal embolism in a preliminary in vitro setting with different types of thrombi.
Endovascular clot retrieval was performed in a vascular model with collateral circulation. White and red thrombi were prepared using whole blood collected from a pig. A Direct Aspiration First Pass Technique (ADAPT), simple stentretrieving with and without proximal flow arrest by a guiding balloon (SR [B+] and SR [B±]), the AspirationRetriever Technique for Stroke (ARTS), and A stentretrieving into an Aspiration catheter with Proximal balloon (ASAP) were performed three times, respectively. The saline samples that were collected at the distal side during each procedure were examined using a particle counter. The particles were counted and categorized into three groups based on size (100 μm).
SR (B-) and SR (B+) could not achieve complete retrieval of the clot, especially using the white thrombus. ASAP was the only method that was able to retrieve the clots in all attempts. In both clot types, SR (B-), SR (B+), and ARTS, which involved a temporary flow restoration through stent deployment, demonstrated the migration of a greater number of particles measuring >100 μm in size than that shown by ADAPT and ASAP.
ASAP was the safest method in terms of intraprocedural clot migration among the five methods evaluated in this study. Temporary flow restoration through stent deployment may affect the dangerous distal clot migration.
本研究旨在评估各种血管内血栓切除术的设备和技术，这些设备和技术在初步体外实验中，针对不同类型血栓，可降低术中远端栓塞风险。
在具有侧支循环的血管模型中进行血管内血栓清除。使用从猪采集的全血制备白色和红色血栓。分别对直接抽吸首次通过技术（ADAPT）、带或不带引导球囊近端血流阻断的简单支架取栓术（SR [B+] 和 SR [B±]）、卒中抽吸取栓技术（ARTS）以及带近端球囊的支架抽吸导管取栓术（ASAP）各进行三次操作。在每次操作过程中，使用颗粒计数器检查从远端采集的盐水样本。对颗粒进行计数，并根据大小（100μm）分为三组。
SR（B-）和 SR（B+）无法完全取出血栓，尤其是使用白色血栓时。ASAP 是唯一在所有尝试中都能取出血栓的方法。在两种血栓类型中，SR（B-）、SR（B+）和 ARTS（通过支架置入实现临时血流恢复）显示，尺寸大于 100μm 的颗粒迁移数量多于 ADAPT 和 ASAP。
在本研究评估的五种方法中，就术中血栓迁移而言，ASAP 是最安全的方法。通过支架置入实现临时血流恢复可能会影响危险的远端血栓迁移。
