Verhey Leonard H, Lyons Leah, Sewell Andrea, Grandfield Ryan M, Khan Muhib, Mazaris Paul, Singer Justin A
Division of Neurological Surgery, Department of Clinical Neurosciences, Spectrum Health, Grand Rapids, MI, USA.
College of Human Medicine, Michigan State University, Grand Rapids, MI, USA.
Interv Neuroradiol. 2024 Aug 21:15910199241272715. doi: 10.1177/15910199241272715.
We (1) evaluated the effect of aspiration tubing diameter on intraluminal pressure and (2) compared thrombectomy outcomes in patients treated using small diameter tubing versus those treated using large diameter vacuum tubing.
Intraluminal negative pressure was measured in a validated benchtop set up where consistency of negative pressure (inHg) was measured between static and dynamic aspiration. Static aspiration refers to activation of vacuum once the catheter is engaged with the clot. Dynamic aspiration refers to activation of vacuum when the catheter is slightly proximal to the clot. Four different sizes of vacuum tubing were trialed. We performed a retrospective analysis of consecutive patients who underwent mechanical thrombectomy. Procedural and functional outcomes were compared.
The large diameter aspiration tubing held a consistent high negative pressure in static and dynamic aspiration (p = 0.152). Tubing types I to III were associated with a significant fall off in negative pressure between static and dynamic technique (p < 0.05). Two-hundred and five patients were included in the retrospective analysis; 124 (60%) underwent thrombectomy using small diameter vacuum tubing, and 81 (40%) using the large tubing. Mean thrombectomy time was shorter with the larger tubing [25.9 (17.9) minutes] versus the small tubing [37.5 (28.5) minutes, p = 0.002]. A greater proportion of patients had a thrombolysis in cerebral infarction score ≥2b in the group treated using the large tubing (78, 99%) than those with the small tubing (96, 78%, p < 0.001).
Vacuum tubing diameter is linearly associated with intraluminal aspiration pressure. These findings have clinical significance as shown by increased recanalization rates and decreased thrombectomy times when large-diameter aspiration tubing is used. Shifting the paradigm toward a flow-based technique using large-bore vacuum tubing ought to be considered.
我们（1）评估了抽吸导管直径对管腔内压力的影响，以及（2）比较了使用小直径导管与大直径真空管治疗的患者的取栓结果。
在经过验证的实验台上测量管腔内负压，在静态和动态抽吸过程中测量负压（英寸汞柱）的一致性。静态抽吸是指导管与血栓接触后启动真空。动态抽吸是指导管略靠近血栓时启动真空。试验了四种不同尺寸的真空管。我们对连续接受机械取栓的患者进行了回顾性分析。比较了手术和功能结果。
大直径抽吸导管在静态和动态抽吸中保持一致的高负压（p = 0.152）。I至III型导管在静态和动态技术之间负压显著下降（p < 0.05）。回顾性分析纳入了205例患者；124例（60%）使用小直径真空管进行取栓，81例（40%）使用大直径导管。大直径导管的平均取栓时间[25.9（17.9）分钟]比小直径导管[37.5（28.5）分钟，p = 0.002]短。使用大直径导管治疗的组中，脑梗死溶栓评分≥2b的患者比例（78例，99%）高于使用小直径导管的组（96例，78%，p < 0.001）。
真空管直径与管腔内抽吸压力呈线性相关。这些发现具有临床意义，使用大直径抽吸导管时再通率增加，取栓时间缩短。应考虑将范式转向使用大口径真空管的基于血流的技术。
