Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(01): 84-88
DOI: 10.4103/ajns.AJNS_237_20
Original Article

Experimental evaluation of the risk of distal embolization during endovascular clot retrieval using various techniques

Tomotaka Ohshima
1   Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi
,
Shigeru Miyachi
1   Neuroendovascular Therapy Center, Aichi Medical University, Nagakute, Aichi
2   Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Background: This study was conducted to evaluate various devices and techniques for endovascular thrombectomy that can reduce the risk of intraprocedural distal embolism in a preliminary in vitro setting with different types of thrombi. Materials and Methods: Endovascular clot retrieval was performed in a vascular model with collateral circulation. White and red thrombi were prepared using whole blood collected from a pig. A Direct Aspiration First Pass Technique (ADAPT), simple stentretrieving with and without proximal flow arrest by a guiding balloon (SR [B+] and SR [B±]), the AspirationRetriever Technique for Stroke (ARTS), and A stentretrieving into an Aspiration catheter with Proximal balloon (ASAP) were performed three times, respectively. The saline samples that were collected at the distal side during each procedure were examined using a particle counter. The particles were counted and categorized into three groups based on size (100 μm). Results: SR (B−) and SR (B+) could not achieve complete retrieval of the clot, especially using the white thrombus. ASAP was the only method that was able to retrieve the clots in all attempts. In both clot types, SR (B−), SR (B+), and ARTS, which involved a temporary flow restoration through stent deployment, demonstrated the migration of a greater number of particles measuring >100 μm in size than that shown by ADAPT and ASAP. Conclusions: ASAP was the safest method in terms of intraprocedural clot migration among the five methods evaluated in this study. Temporary flow restoration through stent deployment may affect the dangerous distal clot migration.

Key-words:

Acute ischemic stroke - aspiration - distal embolization - stent clot retriever

Financial support and sponsorship

Nil.




Publication History

Received: 18 May 2020

Accepted: 12 July 2020

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials. Lancet 2016;387:1723-31.
  • 2 Goto S, Ohshima T, Ishikawa K, Yamamoto T, Shimato S, Nishizawa T, et al. A stent-retrieving into an aspiration catheter with proximal balloon (ASAP) technique: A technique of mechanical thrombectomy. World Neurosurg 2018;109:e468-75.
  • 3 McTaggart RA, Tung EL, Yaghi S, Cutting SM, Hemendinger M, Gale HI, et al. Continuous aspiration prior to intracranial vascular embolectomy (CAPTIVE): A technique which improves outcome. NeuroIntervent Surg 2016;0:1-6
  • 4 Massari F, Henninger N, Lozano JD, Patel A, Kuhn AL, Howk M, et al. ARTS (Aspiration-retriever technique for stroke): Initial clinical experience. Interv Neuroradiol 2016;22:325-32.
  • 5 Turk AS, Frei D, Fiorella D, Mocco J, Baxter B, Siddiqui A, et al. ADAPT FAST study: A direct aspiration first pass technique for acute stroke thrombectomy. NeuroIntervent Surg 2014;6:260-4.
  • 6 Jung S, Gilgen M, Slotboom J, El-Koussy M, Zubler C, Kiefer C, et al. Factors that determine penumbral tissue loss in acute ischaemic stroke. Brain 2013;136:3554-60.
  • 7 Kurre W, Vorlaender K, Aguilar-Pérez M, Schmid E, Bäzner H, Henkes H. Frequency and relevance of anterior cerebral artery embolism caused by mechanical thrombectomy of middle cerebral artery occlusion. AJNR Am J Neuroradiol 2013;34:1606-11.
  • 8 Todo A, Minaeian A, Sahni R, Chao KH. Incidence and outcome of procedural distal emboli using the penumbra thrombectomy for acute stroke. J Neurointerv Surg 2013;5:135-8.
  • 9 Chueh JY, Puri AS, Wakhloo AK, Gounis MJ. Risk of distal embolization with stent retriever thrombectomy and ADAPT. J Neurointerv Surg 2016;8:197-202.
  • 10 Rapp JH, Pan XM, Yu B, Swanson RA, Higashida RT, Simpson P, et al. Cerebral ischemia and infarction from atheroemboli <100 micron in size. Stroke 2003;34:1976-80.