Comparison of a new recirculation thrombectomy catheter with other devices of the same type: in vitro and in vivo evaluations.
OBJECTIVE
To compare a new 7 Fr. Helix thrombectomy catheter with Amplatz thrombectomy devices (ATD) with respect to clot fragmentation efficiency, hemolytic potential, and risk for vascular trauma.


METHODS
Particle size was evaluated following the maceration of 8-to-10-day-old clots, each weighing 6 +/- 0.01 g. The clots were macerated using devices of various sizes, including the 7-Fr. Helix thrombectomy catheter, the 7-Fr. over-the-wire (OTW), 8-Fr. ATD and the 6-Fr. ATD. The number of particles by weight was quantified. The 7-Fr. Helix and the 8-Fr. ATD were tested in the native iliac vein of six dogs without presence of clots. Blood samples were obtained before, during, and at 1, 3, 6, 24, and 48 hours after the procedure, to monitor the hemolytic effects. The treated iliac veins were examined histologically.


RESULTS
Most of the clot was fragmented into particles <10 microm. The mean percentage by weight of the original clot that remained as particles larger than 10 microm was 1.59% in the 7-Fr. Helix group. This was significantly less than 3.10% with the 6-Fr. ATD, 2.57% with 7-Fr. OTW and 2.44% in the 8-Fr. ATD group (<0.01). In vivo results showed a higher plasma free hemoglobin (PFH) level starting 5 minutes after initiating the ATD activation, reaching its peak after completion of the activation, and declining afterward, with return to the baseline at 24 hours. The haptoglobin level tended to decline slightly at 10 minutes, reaching its lowest level at 24 hours, and starting to recover at 48 hours. A similar pattern of PFH and haptoglobin changes was found in both groups. There were no significant differences regarding hemolytic effect of the two tested devices. No significant changes of creatinine were observed for up to 48 hours after procedures. Focal microthrombosis was seen in two sites of two vessels treated with the 7-Fr. Helix and a focal injury of a venous valve was noted in the 8-Fr. ATD group. The media and internal elastic lamina (IEL) were intact in all cases.


CONCLUSIONS
The newly designed 7-Fr. Helix is more effective in fragmentation in vitro clots than the 6 Fr. ATD, 7-Fr. OTW and the 8-Fr. ATD. The 7-Fr. Helix and the 8-Fr. ATD produced hemolytic effects, but they appeared to be tolerated by the animals. The in vivo results indicated that the 7-Fr. Helix appears to be as safe as the 8-Fr. ATD.
Qian
Zhong
Z
Department of Radiology, Louisiana State University Health Sciences Center, New Orleans 70112, USA. zqian@lsuhsc.edu
Kvamme
Peter
P
Raghed
Dina
D
Maynar
Manuel
M
Hamide
John
J
Scheer
William D
WD
Espinoza
Carmen
C
Loscertales
Beatriz
B
Castañeda
Wilfrido R
WR
D000818:Animals; D002404:Catheterization; D004285:Dogs; D004867:Equipment Design; D005069:Evaluation Studies as Topic; D006242:Haptoglobins / Q000032:analysis; D006454:Hemoglobins / Q000032:analysis; D017131:Thrombectomy / Q000295:instrumentation*; D013927:Thrombosis / Q000473:pathology / Q000628:therapy*
D006242:Haptoglobins; D006454:Hemoglobins