Treatment of acute pulmonary embolism: local effects of three hydrodynamic thrombectomy devices in an ex vivo porcine model.
OBJECTIVE
To report an ex vivo study on the local effects of hydrodynamic thrombectomy for the treatment of acute pulmonary embolism (off-label use).


METHODS
Three devices (6-F AngioJet Xpeedior and 6-F and 8-F Oasis) were used for hydrodynamic thrombectomy inside the arteries of 24 inflated and perfused porcine lung explants. Each system was used at multiple positions inside 4 intact and 4 embolized lungs in vessels measuring 2 to 4 mm, 4 to 6 mm, 6 to 8 mm, and 8 to 10 mm. Angiograms prior to, during, and after catheter positioning and system operation were used to detect arterial wall trauma and to measure local clot removal per 30-second cycle. A total of 21 vessel wall samples were subjected to scanning electron microscopy (SEM) to evaluate non-perforating lesions.


RESULTS
All systems were able to remove clot material. The average recanalized vessel length normalized to 30 seconds for vessel diameters of 2 to 4 and 8 to 10 mm, respectively, was 1.17 and 1.75 cm (AngioJet), 0.97 and 0.25 cm (6-F Oasis), and 2.2 and 1.05 cm (8-F Oasis). Perforations occurred during positioning of the 6-F Oasis (4/78 maneuvers) and 8-F Oasis (13/60), but not the AngioJet (0/89); perforations were also seen during system operation (AngioJet: 21/89 activations, 6-F Oasis: 4/78, and 8-F Oasis: 9/60; all lesions inside vessels <6 mm in diameter). SEM showed 35 lesions, 14 with perforation (contrast extravasation) and 21 without perforation (induced by the tip of the guidewire).


CONCLUSIONS
The AngioJet was most efficient in clot removal, followed by the 8-F Oasis. The 6-F Oasis was least efficient, but had fewest complications. According to these experiments, the tested hydrodynamic thrombectomy devices may cause perforations in vessels <6 mm in diameter. Changes in catheter design to reduce system-specific complication rates or to improve the efficacy of clot removal are warranted.
Biederer
Jürgen
J
Department of Diagnostic Radiology, University Hospital Schleswig-Holstein Campus Kiel, Germany. j.biederer@dkfz-heidelberg.de
Charalambous
Nikolas
N
Paulsen
Friedrich
F
Heller
Martin
M
Müller-Hülsbeck
Stefan
S
D000208:Acute Disease; D015901:Angiography, Digital Subtraction; D000818:Animals; D004730:Endothelium, Vascular / Q000473:pathology / Q000648:ultrastructure; D066298:In Vitro Techniques; D008855:Microscopy, Electron, Scanning; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D012212:Rheology; D013552:Swine; D017131:Thrombectomy / Q000295:instrumentation* / Q000379:methods*