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Published on: December 22, 2017
Thrombosis of angiographic catheters in humans: experimental study
A L Bailly1, A Lautier, A Laurent
1Laboratory of Neuroradiology and Therapeutic Angiography, Claude Bernard Research Fund, Paris, France.
Insights
Catheter thrombogenicity, a risk for blood clots, was studied in 31 patients. Smoother catheter surfaces showed higher thrombogenicity, regardless of material composition, highlighting surface texture as a key factor.
Area of Science:
- Biomaterials Science
- Medical Device Engineering
- Clinical Research
Background:
- Catheter use poses a thrombogenicity risk, potentially causing embolization and severe damage.
- Understanding catheter-induced clot formation is crucial for patient safety during procedures like angiography.
Purpose of the Study:
- To evaluate the thrombogenicity of commercially available catheters in a human clinical setting.
- To correlate catheter surface properties with their tendency to cause blood clot formation and occlusion.
Main Methods:
- Five different catheter types were tested in 31 patients undergoing angiographic procedures.
- Blood flow rate (BFR) was monitored for 15 minutes, and catheters were characterized using surface analysis techniques (roughness, FTIR, DSC, ESCA).
Main Results:
- Catheter occlusion occurred in 44% of cases, with an average time to occlusion of 8.5 minutes.
- Smoother catheter surfaces exhibited higher thrombogenicity; however, no correlation was found between chemical composition and thrombogenicity.
- Polyethylene (PE)-based catheters appeared less thrombogenic than Polyamide (PA) catheters in this study.
Conclusions:
- Surface roughness is a significant factor in catheter thrombogenicity, more so than material composition.
- Catheter thrombotic behavior can be classified into three types based on blood flow rate changes.
- Further research into surface modification could mitigate thrombogenicity risks associated with medical catheters.
Abstract:
One of the major problems in the use of catheters is their thrombogenicity since the embolization of clots near the central nervous system or the coronary arteries can cause permanent damage. Catheter thrombogenicity was evaluated in humans during angiographic procedures by their tendency to become occluded. Characterization of catheters was achieved using roughness measurements, FTIR with ATR, DSC and ESCA. The catheters were 5 commercially available catheters, made mainly of polyethylene, Pebax or polyamide sterilized and ready for clinical use. Thirty-one patients due to have an angiographic procedure and with normal blood and hemodynamic parameters were included in the study. The 50 cm catheter test sample was inserted through an introducer into the femoral artery at the beginning of an angiographic procedure. The outcoming blood flow rate (BFR) was continuously monitored by a special computerized device for 15 min or until the total amount of blood reached 30 ml. The angiographic procedure was then normally resumed. DSC and FTIR showed results consistent with the expected composition of catheters. ESCA results showed very high Si/C ratios and could not be explained in all instances. Occlusion of the catheters occurred in 44% of the cases and the average time to obtain occlusion was 8.5 min (3-15 min). Values of the decrease rate of BFR in ml/min2 allowed separation of the catheters into 3 groups of low, medium and high thrombogenicity. However, occlusion occurred at least one time for each type of catheter. Blood volume and BFR curves vs. time allowed the determination of 3 main types of thrombotic behavior: type I shows no significant reduction of BFR; type II shows a progressive decrease in flow rate; type III is much less frequent and shows an abrupt decrease of BFR either quickly followed by a compensatory increase and resuming of a steady flow or by abrupt occlusion. In type II curves the pattern of occlusion follows a classical diffusion model because the Peclet number is greater than 1 and then the classical Higbie solution for diffusion could be used. The most thrombogenic material was the smoothest. There was no correlation between surface chemical composition and thrombogenicity. However, catheters that were based on PE appeared less thrombogenic than PA catheters in this study.
