Chang Yilong, Wu Shuai, Li Qi, Pulli Benjamin, Salmi Darren, Yock Paul, Heit Jeremy J, Zhao Ruike Renee
Department of Mechanical Engineering, Stanford University School of Engineering, Stanford, CA, USA.
Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
Nature. 2025 Jun;642(8067):336-342. doi: 10.1038/s41586-025-09049-0. Epub 2025 Jun 4.
Clot-induced blockage in arteries or veins can cause severe medical conditions. Mechanical thrombectomy is a minimally invasive technique used to treat ischaemic stroke, myocardial infarction, pulmonary embolism and peripheral vascular disease by removing clots through aspiration, stent retriever or cutting mechanisms. However, current mechanical thrombectomy methods fail to remove clots in 10-30% of patients, especially in the case of large, fibrin-rich clots. These methods can also rupture and fragment clots, causing distal emboli and poor outcomes. To overcome these challenges, we develop the milli-spinner thrombectomy, which uses a simple yet innovative mechanics concept to modify the clot's microstructure, facilitating its removal. The milli-spinner works by mechanically densifying the clot's fibrin network and releasing red blood cells through spinning-induced compression and shear forces. It can shrink the clot volume by 95% for easy and fast removal. In vitro tests in pulmonary and cerebral artery flow models and in vivo experiments in swine models demonstrate that the milli-spinner achieves ultrafast clot debulking and high-fidelity revascularization, outperforming aspiration thrombectomy. The milli-spinner thrombectomy directly modifies the clot microstructure to facilitate clot removal, improving mechanical thrombectomy success rates compared with current methods that rely on clot rupture or cutting. This approach offers a promising new direction for mechanical thrombectomy devices, especially for treating ischaemic stroke, pulmonary embolism and peripheral thrombosis.
动脉或静脉中由血栓引起的堵塞可导致严重的病症。机械取栓术是一种微创技术，通过抽吸、支架取栓器或切割机制清除血栓，用于治疗缺血性中风、心肌梗死、肺栓塞和外周血管疾病。然而，目前的机械取栓方法在10%至30%的患者中无法清除血栓，尤其是在血栓较大且富含纤维蛋白的情况下。这些方法还可能使血栓破裂和破碎，导致远端栓塞和不良后果。为了克服这些挑战，我们开发了微型旋转取栓器，它采用了一个简单而创新的力学概念来改变血栓的微观结构，便于其清除。微型旋转取栓器的工作原理是通过机械方式使血栓的纤维蛋白网络致密化，并通过旋转产生的压缩力和剪切力释放红细胞。它可以使血栓体积缩小95%，以便轻松快速地清除。在肺动脉和脑动脉血流模型中的体外测试以及在猪模型中的体内实验表明，微型旋转取栓器实现了超快的血栓减容和高保真的血管再通，优于抽吸取栓术。与目前依赖血栓破裂或切割的方法相比，微型旋转取栓术直接改变血栓的微观结构以促进血栓清除，提高了机械取栓的成功率。这种方法为机械取栓装置提供了一个有前景的新方向，特别是用于治疗缺血性中风、肺栓塞和外周血栓形成。
