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Thrombectomy for acute internal carotid thrombosis: five thrombectomy devices compared
H Chant1, R Ashleigh, C McCollum
1Department of Vascular Surgery, Bristol Royal Infirmary, UK.
Summary
The Hydrolyser and Clot Buster thrombectomy catheters are safest and most effective for clearing internal carotid artery (ICA) thrombosis, unlike balloon embolectomy which risks further embolic damage.
Area of Science:
- Medical Devices
- Vascular Surgery
- Interventional Neurology
Background:
- Internal carotid artery (ICA) thrombosis poses a significant risk of ischemic stroke.
- Effective thrombectomy is crucial for restoring blood flow and preventing neurological deficits.
- Commercially available thrombectomy devices vary in their safety and efficacy profiles.
Purpose of the Study:
- To evaluate the safety and efficiency of five commercially available thrombectomy catheters in simulated ICA thrombosis.
- To compare thrombus removal rates, pressure dynamics, and distal embolization potential across different devices.
Main Methods:
- A comparative in vitro study was conducted using a simulated ICA model filled with human thrombus.
- Five thrombectomy devices were tested under varying back pressures (10 and 30 cm H2O).
- Thrombus clearance, tip pressure changes, and distal embolization were assessed using flow cytometry.
Main Results:
- AngioJet demonstrated the highest thrombus clearance (95%), while Acolysis System showed the least (34%).
- Hydrolyser and Clot Buster generated only negative tip pressures, indicating a safer profile.
- Fogarty balloon catheter at 10 cm H2O resulted in the greatest distal embolization (P<0.05).
Conclusions:
- Balloon embolectomy for ICA thrombosis carries a risk of further embolic cerebral damage.
- The Hydrolyser and Clot Buster devices show significant promise for safe and effective ICA thrombectomy.
- Device selection is critical to optimize outcomes and minimize complications in thrombectomy procedures.