title: Quantitative assessment of device-clot interaction for stent retriever thrombectomy.
abstract: OBJECTIVE
  Rapid revascularization in emergent large vessel occlusion with endovascular embolectomy has proven clinical benefit. We sought to measure device-clot interaction as a potential mechanism for efficient embolectomy.
  
  
  METHODS
  Two different radiopaque clot models were injected to create a middle cerebral artery occlusion in a patient-specific vascular phantom. A radiopaque stent retriever was deployed within the clot by unsheathing the device or a combination of unsheathing followed by pushing the device (n=8/group). High-resolution cone beam CT was performed immediately after device deployment and repeated after 5 min. An image processing pipeline was created to quantitatively evaluate the volume of clot that integrates with the stent, termed the clot integration factor (CIF).
  
  
  RESULTS
  The CIF was significantly different for the two deployment variations when the device engaged the hard clot (p=0.041), but not the soft clot (p=0.764). In the hard clot, CIF increased significantly between post-deployment and final imaging datasets when using the pushing technique (p=0.019), but not when using the unsheathing technique (p=0.067). When we investigated the effect of time on CIF in the different clot models disregarding the technique, the CIF was significantly increased in the final dataset relative to the post-deployment dataset in both clot models (p=0.004-0.007).
  
  
  CONCLUSIONS
  This study demonstrates in an in vitro system the benefit of pushing the Trevo stent during device delivery in hard clot to enhance integration. Regardless of delivery technique, clot-device integration increased in both clot models by waiting 5 min.
authors.affiliation: Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Kajo
authors.identifier: http://orcid.org/0000-0003-1099-9498
authors.initials: K
authors.lastname: van der Marel
authors.affiliation: Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Ju-Yu
authors.initials: JY
authors.lastname: Chueh
authors.affiliation: Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Olivia W
authors.initials: OW
authors.lastname: Brooks
authors.affiliation: Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: King
authors.affiliation: Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Miklos G
authors.initials: MG
authors.lastname: Marosfoi
authors.affiliation: Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Erin T
authors.initials: ET
authors.lastname: Langan
authors.affiliation: Department of Preclinical Science, Stryker Neurovascular, Fremont, California, USA.
authors.forename: Sarena L
authors.initials: SL
authors.lastname: Carniato
authors.affiliation: Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gounis
authors.affiliation: Emory University School of Medicine/Grady Memorial Hospital-Marcus Stroke and Neuroscience Center, Atlanta, Georgia, USA.
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
authors.affiliation: Department of Radiology, New England Center for Stroke Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
authors.forename: Ajit S
authors.initials: AS
authors.lastname: Puri
keywords: CT; Stent; Stroke; Technique; Thrombectomy
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