Nogueira Raul G, Fitzgerald Seán, Murillo Artigues Miquel, Adedeji Akorede Rei, Mullins Liam, Thornton John
Department of Neurology and Neurosurgery, UPMC Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Perfuze Ltd., Galway, Ireland.
Interv Neuroradiol. 2025 Jun 12:15910199251349672. doi: 10.1177/15910199251349672.
BackgroundIn mechanical thrombectomy procedures, physicians are often forced to cross the clot to get more support in tortuous anatomy. Stentriever procedures always require traversing the clot. Novel delivery assist catheters with a tapered distal tip have been developed to aid aspiration catheter delivery. This study compares a novel delivery assist catheter to conventional support strategies in terms of reperfusion and distal embolization. The impact of remaining proximal versus entering the clot is also investigated, as is the impact of incorporating a Superbore 088 catheter.MethodsSoft, medium, and stiff ovine blood clots were used to form ICA/M1 occlusions in an in-vitro thrombectomy model. Two approaches were tested: navigating the aspiration catheter with and without crossing/entering the clot with support devices. Six setups were tested: Millipede + Zipline, Millipede + Millipede + Zipline, Millipede + Zipline, SOFIA Plus + 021 Microcatheter, SOFIA Plus + 3MAX, SOFIA Plus + 021 Microcatheter + Stentriever. Each setup was tested nine times totaling 72 tests. Revascularization endpoints were First-Pass-Effect (FPE), final complete revascularization, and distal embolization.ResultsAvoiding clot entry was associated with higher FPE rates, improved final revascularization, and fewer distal emboli. Using a 3MAX as a microcatheter and crossing the clot resulted in more distal emboli than a standard 021 microcatheter or stentriever procedure. Millipede + Zipline configuration achieved the highest FPE (67%) when the clot was not crossed (vs. 56% with clot entry). Both 070 aspiration catheters had the same FPE rate (33%) but using Millipede for flow control with Millipede improved the FPE rate (44%). Of the conventional techniques, SOFIA Plus + 021 Microcatheter + Stentriever was associated with the highest FPE rate (44%).ConclusionsRemaining proximal to the clot is advantageous. Next-generation delivery catheters, like Zipline, may enhance catheter delivery without increasing embolization risk. Using larger internal catheters, such as 3MAX, leads to higher rates of emboli when crossing the clot.
背景
在机械取栓手术中，医生常常被迫穿过血栓，以便在复杂的血管解剖结构中获得更多支撑。支架取栓手术总是需要穿过血栓。已开发出具有锥形远端尖端的新型输送辅助导管，以辅助抽吸导管的输送。本研究比较了一种新型输送辅助导管与传统支撑策略在再灌注和远端栓塞方面的差异。还研究了留在近端与进入血栓的影响，以及使用Superbore 088导管的影响。
方法
在体外取栓模型中，使用软、中、硬三种程度的羊血栓形成颈内动脉/大脑中动脉M1段闭塞。测试了两种方法：在有或没有使用支撑装置穿过/进入血栓的情况下引导抽吸导管。测试了六种设置：Millipede + Zipline、Millipede + Millipede + Zipline、Millipede + Zipline、SOFIA Plus + 021微导管、SOFIA Plus + 3MAX、SOFIA Plus + 021微导管 + 支架取栓器。每种设置测试9次，共72次测试。血管再通终点为首次通过效应（FPE）、最终完全再通和远端栓塞。
结果
避免进入血栓与更高的FPE率、更好的最终再通以及更少的远端栓子相关。使用3MAX作为微导管并穿过血栓比标准的021微导管或支架取栓手术导致更多的远端栓子。当不穿过血栓时，Millipede + Zipline配置实现了最高的FPE（67%）（穿过血栓时为56%）。两种070抽吸导管的FPE率相同（33%），但使用Millipede进行流量控制可提高FPE率（44%）。在传统技术中，SOFIA Plus + 021微导管 + 支架取栓器的FPE率最高（44%）。
结论
留在血栓近端是有利的。像Zipline这样的下一代输送导管可能会在不增加栓塞风险的情况下增强导管输送。使用更大的内部导管，如3MAX，在穿过血栓时会导致更高的栓子发生率。
