Balloon-Guide Catheters Are Needed for Effective Flow Reversal during Mechanical Thrombectomy

Area of Science:

• Interventional Neurology
• Vascular Surgery
• Biomedical Engineering

Background:

• Effective blood flow management is critical for safety and success in carotid artery mechanical thrombectomy.
• The necessity of balloon-guide catheters versus large-bore sheaths for flow control remains debated.

Purpose of the Study:

• To compare the hemodynamic effects of aspiration using a large-bore sheath versus a balloon-guide catheter in a porcine carotid artery model.
• To evaluate flow characteristics during mechanical thrombectomy simulations.

Main Methods:

• Investigated blood flow in a porcine common carotid artery using an 8F sheath and an 8F balloon-guide catheter.
• Assessed hemodynamics with and without aspiration (VacLok syringe, Penumbra pump) via continuous duplex sonography.

Main Results:

• Aspiration via 8F sheath caused significant flow reduction but maintained antegrade flow, or led to vessel collapse/oscillatory flow.
• Balloon-guide catheter inflation arrested flow, and subsequent aspiration induced significant flow reversal.
• Pump aspiration with balloon-guide catheter resulted in -1100 ± 230 mL/min flow reversal (P < .001).

Conclusions:

• Balloon-guide catheters enable reliable blood flow arrest and reversal during mechanical thrombectomy.
• Aspiration through an 8F sheath can lead to detrimental vessel collapse or unpredictable flow patterns.