From the 2nd Department of Radiology (M.J., Medical University of Gdansk, Gdansk, Poland.
Stroke Unit (M.J., M.R.), Vall d'Hebron Research Institute, Barcelona, Spain.
AJNR Am J Neuroradiol. 2024 Nov 7;45(11):1708-1715. doi: 10.3174/ajnr.A8369.
Mechanical thrombectomy is a fundamental intervention for acute ischemic stroke treatment. While conventional techniques are effective, cyclic aspiration (CyA) shows potential for better recanalization rates. We aim to investigate factors affecting CyA and compare them with static aspiration (StA).
StA setup consisted of an aspiration pump connected to pressure transducer. CyA was tested with 5 subsequent iterations: single solenoid valve with air plus saline (i1) or saline alone (i2) as aspiration medium; 2 solenoid valves with air plus saline (i3) as aspiration medium; complete air removal and saline feeding (i4); and pressurized saline feeding (i5). To assess the efficacy of clot ingestion, the pressure transducer was replaced with a distal aspiration catheter. Moderately stiff clot analogs (15 mm) were used to investigate the ingestion quantified as clot relative weight loss. Additionally, the aspiration flow rate was assessed for each setup.
With CyA i1, the amplitude of the achieved negative pressure waves declined with increasing frequencies but progressively increased with each subsequent iteration, achieving a maximum amplitude of 81 kPa for i5 at 1 Hz. Relative clot weight loss was significantly higher with i5 at 5 Hz than with StA (100% versus 37.8%; = .05). Aspiration flow rate was lower with CyA than with StA (i5 at 5 Hz: 199.8 mL/min versus StA: 311 mL/min; < .01).
CyA with the appropriate setup may represent an encouraging innovation in mechanical thrombectomy, offering a promising pathway for improving efficacy in clot ingestion and recanalization. The observed benefits warrant confirmation in a clinical setting.
机械血栓切除术是急性缺血性脑卒中治疗的基本干预手段。虽然传统技术有效，但循环抽吸（CyA）显示出更高的再通率潜力。我们旨在研究影响 CyA 的因素，并将其与静态抽吸（StA）进行比较。
StA 设置包括连接到压力传感器的抽吸泵。CyA 经过 5 次迭代测试：带有空气和盐水（i1）或仅盐水（i2）作为抽吸介质的单电磁阀；带有空气和盐水（i3）作为抽吸介质的 2 个电磁阀；完全去除空气并供给盐水（i4）；以及加压盐水供给（i5）。为了评估血栓摄取的效果，将压力传感器替换为远端抽吸导管。使用中度刚性的血栓模拟物（15 毫米）来研究作为相对血栓重量损失的摄取量。此外，评估了每种设置的抽吸流速。
在 CyA i1 中，随着频率的增加，达到的负压波的幅度降低，但随着每个后续迭代的增加而逐渐增加，在 1 Hz 时达到 81 kPa 的最大幅度。在 5 Hz 时，i5 的相对血栓重量损失明显高于 StA（100%比 37.8%； <.05）。CyA 的抽吸流速低于 StA（5 Hz 时的 i5：199.8 mL/min 比 StA：311 mL/min； <.01）。
具有适当设置的 CyA 可能代表机械血栓切除术的一项令人鼓舞的创新，为提高血栓摄取和再通效果提供了有前途的途径。观察到的益处需要在临床环境中得到证实。
