Mechanical assistance for enhancement of in vitro effectiveness for hydrodynamic thrombectomy

To determine whether the efficacy for clot removal and procedure-related peripheral particle embolization for the hydrodynamic thrombectomy device CF 105 AngioJet (CF 105) can be enhanced with the use of guiding catheters and an occlusion balloon in an in-vitro flow model.

Thrombectomy of clots (n = 97) from 5-day-old human blood (range, 9.28-9.77 g) was performed with the CF 105 alone, with additional guide wires (CF 1050.014/0.018), with a 30 degree angled tip (CF 10530 degrees), with guiding catheters (CF 105MP/HS), and with an additional occlusion balloon (CF 105OB) in a flow model (flow 1 L/min) of silicone tubes (inner tube diameter, 7 mm).

Mean thrombectomy time ranged from 28.71 seconds (CF 105OB) to 37.02 seconds (CF 10530 degrees). When a guide wire was used, the time for thrombectomy was not prolonged. None of the devices tested worked isovolumetrically. The ratio of applied saline and aspirated fluid (0.34) for CF 105 alone was significantly better than for CF 1050.014/0.018 (0.49/0.60; for both P < 0.001). Compared with CF 105 alone (273.16 mg), wall-adhesive thrombus was reduced significantly with CF 105MP (43.66 mg), CF 105HS (48.66 mg), and CF 10530 degrees (97.27 mg; P < 0.001 for all). Compared with the highest rate of embolism for CF 105 alone (4.62%), CF 105OB (2.50%; P < 0.001), CF 105HS (3.04%; P < 0.001), CF 105MP (3.49%; P < 0.001), and CF 105018 (3.64%; P < 0.001) produced better ratios.

The use of guiding catheters and occlusion balloons is feasible to enhance hydrodynamic thrombectomy in vitro. This combination reduces procedure-related peripheral particle embolization and wall-adhesive thrombus during hydrodynamic thrombectomy. To avoid blood loss, the device should be used only with a 0.018" guide wire.