Pressman Elliott, Amin Sheyar, Vakharia Kunal, Guerrero Waldo R, Thanki Shail, Siddiqui Adnan H, Mokin Maxim
Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA.
Ochsner Lafayette General Neuroscience Center, Lafayette, LA, USA.
Interv Neuroradiol. 2025 May 13:15910199251341382. doi: 10.1177/15910199251341382.
BackgroundFactors responsible for failure of aspiration thrombectomy in patients with acute ischemic stroke are poorly understood. In order to examine catheter-clot interactions, we modified our current aspiration thrombectomy technique by performing contrast injections near the tip of the aspiration catheter prior to the initiation of aspiration thrombectomy.MethodsSmall volume injections of contrast were performed using a microcatheter positioned inside the aspiration catheter immediately proximal to the occlusion site. Continuous fluoroscopy during the entire duration of each aspiration pass was recorded. We report our initial results with this new technique and examine potential associations of patterns of contrast behavior with procedural success of each thrombectomy pass.ResultsSeventeen patients were included in final analysis, consisting of 24 total aspiration thrombectomy passes. Microcatheter injections showed no safety concerns. Three angiographic patterns of contrast behavior near the aspiration catheter tip were observed: "occlusive" with no forward contrast flow, "side branch opacification" and "anterograde opacification" with anterograde flow. Movement of the contrast column during aspiration thrombectomy depended on the degree of aspiration catheter redundancy. Manual reduction of excessive catheter turns and higher position of long guide sheath at the petrous or cavernous segments seemed to improve contrast clearance and aspiration force.ConclusionsThis initial experience indicates that multiple complex factors may affect success rates of aspiration thrombectomy. The technique of microcatheter injection near the occlusion site may prove helpful in optimizing the existing aspiration thrombectomy techniques.
背景
急性缺血性中风患者抽吸血栓切除术失败的相关因素尚不清楚。为了研究导管与血栓的相互作用，我们在开始抽吸血栓切除术之前，通过在抽吸导管尖端附近进行造影剂注射，对当前的抽吸血栓切除术技术进行了改进。
方法
使用位于抽吸导管内紧邻闭塞部位近端的微导管进行小剂量造影剂注射。记录每次抽吸过程中全程的连续荧光透视情况。我们报告这项新技术的初步结果，并研究造影剂行为模式与每次血栓切除术过程成功之间的潜在关联。
结果
最终分析纳入了17例患者，共进行了24次抽吸血栓切除术。微导管注射未显示出安全问题。观察到抽吸导管尖端附近造影剂行为的三种血管造影模式：无正向造影剂流动的“闭塞型”、“侧支显影”和有顺行血流的“顺行显影”。抽吸血栓切除术期间造影剂柱的移动取决于抽吸导管冗余的程度。手动减少过多的导管扭曲以及将长导鞘置于岩骨段或海绵窦段的较高位置似乎可改善造影剂清除和抽吸力量。
结论
这一初步经验表明，多种复杂因素可能影响抽吸血栓切除术的成功率。闭塞部位附近的微导管注射技术可能有助于优化现有的抽吸血栓切除术技术。
