Direct Aspiration versus Combined Technique for Distal Medium-Vessel Occlusions: Comparison on a Human Placenta Model
J Burel1,2, E Gerardin1, C Papagiannaki1
1From the Departments of Radiology (J.B., E.G., C.P., P.-L.H., J.-N.D.).
AJNR. American Journal of Neuroradiology
|March 23, 2023
Summary
Direct aspiration for mechanical thrombectomy may be risky if the catheter cannot reach the clot. The combined technique showed higher recanalization but also more harm, suggesting direct aspiration as a first-line option pending clinical studies.
Area of Science:
- Neurology
- Interventional Radiology
- Biomedical Engineering
Background:
- Distal medium-vessel occlusions present challenges for mechanical thrombectomy.
- Intravenous thrombolysis alone may be insufficient for these occlusions.
Purpose of the Study:
- To determine the optimal mechanical thrombectomy technique for distal medium-vessel occlusions.
- To compare direct aspiration versus a combined technique using a human placenta model.
Main Methods:
- Twenty-four procedures compared direct aspiration (n=12) and combined techniques (n=12).
- Catheter positions (contact vs. distance) and clot types (RBC-rich vs. fibrin-rich) were evaluated.
- First-pass recanalization, arterial collapse, and traction were assessed.
Main Results:
- First-pass recanalization was less frequent with direct aspiration (41.7%) than the combined technique (75.0%), though not statistically significant (P=.098).
- Direct aspiration led to significantly less arterial collapse (P<.001) and traction (P=.001).
- When the catheter was not in contact, direct aspiration resulted in no recanalization and systematic arterial collapse.
Conclusions:
- Direct aspiration may be a suitable first-line approach for mechanical thrombectomy in distal occlusions.
- The combined technique may be more harmful.
- Aspiration alone is risky if the catheter cannot reach the clot; further clinical studies are needed.
