Comparison of modern stroke thrombectomy approaches using an in vitro cerebrovascular occlusion model.
OBJECTIVE
A new in vitro cerebrovascular occlusion model of the intracranial circulation was developed recently for testing thrombectomy devices. Using this model, we compared recanalization success associated with different modern endovascular thrombectomy approaches.


METHODS
Model experiments were performed in 4 thrombectomy test groups: 1) primary or direct Stentriever thrombectomy with a conventional guide catheter (control group), 2) primary Stentriever thrombectomy with a balloon-guide catheter, 3) combined Stentriever-continuous aspiration approach, and 4) direct aspiration alone. Successful recanalization was defined as a TICI score of 2b or 3.


RESULTS
Seventy-one thrombectomy experiments were conducted. Similar rates of TICI 2b-3 scores were achieved with balloon-guide and conventional guide catheters (P = .34). The combined Stentriever plus aspiration approach and the primary aspiration thrombectomy resulted in significantly higher rates of TICI 2b or 3 than the conventional guide-catheter approach in the control group (P = .008 and P = .0001, respectively). The primary Stentriever thrombectomy with the conventional guide catheter showed the highest rate of embolization to new territories (53%).


CONCLUSIONS
Data from our in vitro model experiments show that the Stentriever thrombectomy under continuous aspiration and primary aspiration thrombectomy approaches led to the highest degree of recanalization.
From the Departments of Neurosurgery (M.M., E.I.L., A.H.S.).
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Mokin
Biomedical Engineering (S.V.S.N., C.N.I.) Electrical Engineering (S.V.S.N.) Mechanical and Aerospace Engineering (S.V.S.N.).
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Setlur Nagesh
Biomedical Engineering (S.V.S.N., C.N.I.) Toshiba Stroke and Vascular Research Center (C.N.I., E.I.L., A.H.S.), University at Buffalo, State University of New York, Buffalo, New York.
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From the Departments of Neurosurgery (M.M., E.I.L., A.H.S.) Radiology (E.I.L., A.H.S.) Toshiba Stroke and Vascular Research Center (C.N.I., E.I.L., A.H.S.), University at Buffalo, State University of New York, Buffalo, New York.
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Levy
From the Departments of Neurosurgery (M.M., E.I.L., A.H.S.) Radiology (E.I.L., A.H.S.) Toshiba Stroke and Vascular Research Center (C.N.I., E.I.L., A.H.S.), University at Buffalo, State University of New York, Buffalo, New York Jacobs Institute (A.H.S.), Buffalo, New York. asiddiqui@ubns.com.
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Siddiqui
D005260:Female; D006801:Humans; D020767:Intracranial Thrombosis / Q000601:surgery*; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome