title: An in vitro evaluation of distal emboli following Lazarus Cover-assisted stent retriever thrombectomy.
abstract: BACKGROUND
  Formation of clot fragments during mechanical thrombectomy for acute ischemic stroke can occlude the distal vasculature, which may reduce the rate of good clinical outcome.
  
  
  OBJECTIVE
  To examine the hypothesis that distal embolization can be reduced using stent retriever thrombectomy in combination with Lazarus Cover technology.
  
  
  METHODS
  Hard, fragment-prone clots were used to create middle cerebral artery occlusions in a vascular phantom. Three different treatment strategies using Solitaire FR included: group 1-proximal flow control with an 8F balloon guide catheter (BGC), group 2-thrombectomy through a 6F conventional guide catheter (CGC), and group 3-a similar thrombectomy procedure to group 2 but including the Lazarus Cover device. The primary endpoint was distal emboli quantified by the number and size of the clot debris.
  
  
  RESULTS
  The Cover-assisted stent retriever thrombectomy significantly reduced the generation of clot fragments >200 μm as compared with thrombectomy with a CGC, and was similar to the BGC group. Particle size distribution <200 μm was similar across the groups. All groups were associated with high rates of recanalization, with only one failed recanalization with partial clot retention after three passes in one experiment of stent retriever thrombectomy through a CGC. Use of the adjunctive Cover device did not prolong the procedure as compared with control groups.
  
  
  CONCLUSIONS
  For a fragment-prone clot, Solitaire thrombectomy in conjunction with the Cover device may lower the risk of distal embolization and is comparable to BGC-protected embolectomy.
authors.affiliation: Department of Radiology, New England Center for Stroke Research, University of Massachusetts, 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, Worcester, Massachusetts, USA.
authors.forename: Ajit S
authors.initials: AS
authors.lastname: Puri
authors.affiliation: Department of Radiology, New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gounis
mesh_terms: D002545:Brain Ischemia / Q000601:surgery; D002533:Cerebral Angiography; D020878:Device Removal / Q000009:adverse effects* / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D020244:Infarction, Middle Cerebral Artery / Q000601:surgery; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D010316:Particle Size; D015607:Stents; D020521:Stroke / Q000601:surgery; D017131:Thrombectomy / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome
keywords: Device; Stroke; Thrombectomy