Bilgin Cem, Li Jiahui, Bayraktar Esref Alperen, Naylor Ryan M, Oliver Alexander A, Ueki Yasuhito, Cortese Jonathan R, Rinaldo Lorenzo, Kadirvel Ramanathan, Brinjikji Waleed, Cloft Harry J, Kallmes David F
From the Department of Radiology (C.B., E.A.B., A.A.O., J.R.C., R.K., W.B., D.F.K.), Mayo Clinic Rochester, Rochester, Minnesota
Stroke Research, Vall d'Hebron Research Institute (J.L.), Barcelona, Spain.
AJNR Am J Neuroradiol. 2025 Jan 8;46(1):90-95. doi: 10.3174/ajnr.A8409.
A single-aspiration maneuver using a large-volume syringe is a common and effective technique for aspiration thrombectomy. Multiple aspiration cycles using large aspiration syringes have been proposed as a means to improve the efficacy over single aspiration. In this study, we sought to investigate the efficacy of a "triple aspiration technique" in which a large-volume syringe is cycled 3 times before catheter retraction during aspiration thrombectomy.
A 3D-printed adult vasculature was used as a benchtop thrombectomy platform. Fibrin-rich and red blood cell-rich clots were prepared in centrifuge tubes using human plasma, red blood cells, and calcium chloride. Next, clots were placed in the carotid terminus of the model, and the performances of 3 different aspiration techniques-triple syringe, single syringe, and continuous pump aspiration-were compared in a randomized manner (1:1:1). Outcomes of interest included first-pass efficacy (FPE), complete clot removal (final modified TICI 2c/3), the number of thrombectomy attempts to achieve modified TICI 2c/3, vacuum pressure, and distal embolization. The distal emboli were detected using a 70-μm cell strainer placed at the outflow of the model and quantified using an image-processing algorithm. The vacuum pressures were measured using a pressure transducer.
A total of 102 replicates were performed, 34 for each technique. The triple-aspiration technique provided a significantly higher rate of FPE than the syringe and pump aspiration techniques (67.6% versus 41.1%, = .02). Additionally, the triple-aspiration technique achieved complete clot removal with a significantly lower mean number of thrombectomy attempts compared with single-syringe aspiration (1.2 [SD, 0.5] versus 1.8 [SD, 0.8], = .005). The triple-aspiration technique generated significantly higher mean vacuum pressure than both the single-syringe and vacuum pump aspiration (28.3 [SD, 0.2] versus 27.2 [SD, 0.3], = .002 and 26.2 [SD, 0.4], = .001, respectively). The differences in complete clot removal and distal embolization parameters were not statistically significantly different across the groups.
Our findings suggest that the triple aspiration technique can improve FPE rates and vacuum pressure in aspiration thrombectomy. Further studies are needed to examine the safety and efficacy of triple aspiration in the clinical setting.
使用大容量注射器进行单次抽吸操作是一种常见且有效的血栓抽吸技术。有人提出使用大型抽吸注射器进行多次抽吸循环,作为提高单次抽吸疗效的一种方法。在本研究中,我们试图研究“三次抽吸技术”的疗效,即在血栓抽吸过程中,大容量注射器在导管回撤前循环使用3次。
使用3D打印的成人血管系统作为台式血栓切除术平台。使用人血浆、红细胞和氯化钙在离心管中制备富含纤维蛋白和富含红细胞的血凝块。接下来,将血凝块放置在模型的颈动脉末端,并以随机方式(1:1:1)比较三种不同抽吸技术——三次注射器抽吸、单次注射器抽吸和连续泵抽吸——的性能。感兴趣的结果包括首次通过疗效(FPE)、完全清除血凝块(最终改良脑梗死溶栓分级2c/3级)、达到改良脑梗死溶栓分级2c/3级所需的血栓切除术尝试次数、真空压力和远端栓塞。使用放置在模型流出端的70μm细胞滤网检测远端栓子,并使用图像处理算法进行量化。使用压力传感器测量真空压力。
共进行了102次重复操作,每种技术各34次。三次抽吸技术的首次通过疗效率显著高于注射器抽吸和泵抽吸技术(67.6%对41.1%,P = 0.02)。此外,与单次注射器抽吸相比,三次抽吸技术实现完全清除血凝块所需的血栓切除术平均尝试次数显著更低(1.2[标准差,0.5]对1.8[标准差,0.8],P = 0.005)。三次抽吸技术产生的平均真空压力显著高于单次注射器抽吸和真空泵抽吸(分别为28.3[标准差,0.2]对27.2[标准差,0.3],P = 0.002和26.2[标准差,0.4],P = 0.001)。各组在完全清除血凝块和远端栓塞参数方面的差异无统计学意义。
我们的研究结果表明,三次抽吸技术可提高血栓抽吸术中的首次通过疗效率和真空压力。需要进一步研究以检验三次抽吸在临床环境中的安全性和疗效。