Primary stentriever versus combined stentriever plus aspiration thrombectomy approaches: in vitro stroke model comparison.
BACKGROUND
Artificial stroke models can be used for testing various thrombectomy devices.


OBJECTIVE
To determine the value of combined stentriever-aspiration thrombectomy compared with the stentriever-alone approach.


METHODS
We designed an in vitro model of the intracranial circulation with a focus on the middle cerebral artery (MCA) that closely resembles the human intracranial circulation. After introducing fresh clot in the MCA, we used conventional biplane angiography and microangiographic fluoroscopy to compare recanalization rates and occurrence of emboli in new, unaffected territory for thrombectomy approaches in which a stentriever (Solitaire flow restoration stentriever, Covidien) was used alone or in combination with continuous manual aspiration through a Navien catheter (Covidien).


RESULTS
In a total of 22 experiments (11 for each approach), successful clot delivery to the MCA was achieved in all cases. Successful angiographic recanalization (thrombolysis in cerebral infarction score of 2b-3) was achieved more frequently with the combined stentriever-aspiration approach than with the stentriever-alone approach (in 10 vs 4 experiments, p=0.023). Emboli in new territory occurred in three experiments with the stentriever-alone approach, and none were seen with the combined approach (p=0.21).


CONCLUSIONS
The combined stentriever-aspiration approach to thrombectomy leads to better angiographic recanalization rates than use of the stentriever alone. Further experiments are needed to test the value of balloon-guide catheters and aspiration performed using other types of catheters and modes of aspiration.
Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA.
Maxim
M
Mokin
Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Biomedical Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
Ciprian N
CN
Ionita
Department of Biomedical Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Electrical Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Mechanical and Aerospace Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA.
Swetadri Vasan Setlur
SV
Nagesh
Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Biomedical Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Mechanical and Aerospace Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Physiology and Biophysics, University at Buffalo, State University of New York, Buffalo, New York, USA.
Stephen
S
Rudin
Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
Elad I
EI
Levy
Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
Adnan H
AH
Siddiqui
D000792:Angiography; D002560:Cerebrovascular Circulation / Q000502:physiology*; D006801:Humans; D020768:Middle Cerebral Artery / Q000473:pathology*; D008959:Models, Neurological; D015607:Stents; D020521:Stroke / Q000628:therapy*; D017131:Thrombectomy / Q000295:instrumentation* / Q000379:methods*; D013927:Thrombosis / Q000628:therapy*
Stroke; Technique; Thrombectomy