Reymond Philippe, Roussinova Evgenia, Brina Olivier, Hofmeister Jeremy, Bernava Gianmarco, Rosi Andrea, Galand William, Lovblad Karl-Olof, Pereira Vitor M, Bouri Mohamed, Machi Paolo
Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland.
Translational Neural Engineering Lab (TNE), Swiss Federal Institute of Technology Lausanne, Lausanne, Switzerland.
J Neurointerv Surg. 2025 Mar 17;17(4):415-421. doi: 10.1136/jnis-2024-021477.
The identification of specific clot characteristics before mechanical thrombectomy (MTB) might allow the selection of the most effective first-line technique, thus potentially improving the procedural outcome. We aimed to evaluate if the microwire push forces could extrapolate information on clot consistency and extension before MTB, based on clot mechanical properties.
We measured in vitro the forces exerted on the proximal extremity of the guidewire during the advancement and retrieval of the guidewire through clot analogs of different compositions. In addition, we analyzed the forces exerted on the guidewire to extrapolate information about the location of the proximal and distal extremities of the clot analogs.
The maximum forces recorded during the whole penetration phase were significantly different for hard and soft clots (median values, 55.6 mN vs 15.4 mN, respectively; P<0.0001). The maximum slope of the force curves recorded during the advancement of the guidewire for the first 3 s of penetration also significantly differentiated soft from hard clot analogs (7.6 mN/s vs 23.9 mN/s, respectively; P<0.0001). In addition, the qualitative analysis of the shape of the force curves obtained during the advancement and retrieval of the guidewire showed a good potential for the identification of the proximal and distal edges of the clot analogs.
Our results demonstrated that it was possible to differentiate between soft and hard clot analogs. Furthermore, force measurements could give important information about the location of the clot extremities. Such an approach might support the selection of the first-line MTB technique, with the potential to improve the outcome.
在进行机械血栓切除术（MTB）之前识别特定的血栓特征，可能有助于选择最有效的一线技术，从而有可能改善手术结果。我们旨在评估微导丝推力是否能根据血栓的力学特性，在MTB之前推断出血栓的稠度和范围信息。
我们在体外测量了导丝在推进和回撤过程中，通过不同成分的血栓模拟物时施加在导丝近端的力。此外，我们分析了施加在导丝上的力，以推断出血栓模拟物近端和远端的位置信息。
在整个穿透阶段记录的最大力，硬血栓和软血栓之间存在显著差异（中位数分别为55.6 mN和15.4 mN；P<0.0001）。在穿透的前3秒导丝推进过程中记录的力曲线的最大斜率，也能显著区分软血栓模拟物和硬血栓模拟物（分别为7.6 mN/s和23.9 mN/s；P<0.0001）。此外，对导丝推进和回撤过程中获得的力曲线形状进行定性分析，显示出识别血栓模拟物近端和远端边缘的良好潜力。
我们的结果表明，可以区分软血栓模拟物和硬血栓模拟物。此外，力的测量可以提供有关血栓末端位置的重要信息。这种方法可能有助于一线MTB技术的选择，有可能改善手术结果。
