This Article Full Text Full Text (PDF) All Versions of this Article: 37/12/3019    most recent 01.STR.0000248457.55493.85v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gralla, J. Articles by Brekenfeld, C. Search for Related Content PubMed PubMed Citation Articles by Gralla, J. Articles by Brekenfeld, C. Related Collections Animal models of human disease Embolic stroke Emergency treatment of Stroke Angiography

(Stroke. 2006;37:3019.)
© 2006 American Heart Association, Inc.

Original Contributions

Mechanical Thrombectomy for Acute Ischemic Stroke

Thrombus–Device Interaction, Efficiency, and Complications In Vivo

Jan Gralla, MD; Gerhard Schroth, MD; Luca Remonda, MD; Krassen Nedeltchev, MD; Johannes Slotboom, PhD Caspar Brekenfeld, MD

From the Departments of Interventional and Diagnostic Neuroradiology (J.G., G.S., L.R., J.S., C.B.), Interventional and Diagnostic Radiology (J.G.), and Neurology (K.N.), University of Bern, Switzerland.

Correspondence to Caspar Brekenfeld, Department of Neuroradiology, Freiburgstrasse 4, CH-3010 Bern, Switzerland. E-mail caspar.brekenfeld{at}insel.ch

Background and Purpose— Mechanical thrombectomy is a promising new modality of interventional stroke treatment. The various devices differ with regard to where they apply force on the thrombus, taking a proximal approach such as aspiration devices or a distal approach such as basket-like devices. The study compares the in vivo effectiveness and thrombus–device interaction of these 2 approaches.

Methods— Angiography and embolization with a radioopaque whole blood thrombus was performed in 10 swine. Mechanical thrombectomy was performed in 20 cranial vessels using a proximal aspiration device (Vasco35) and a distal basket-like device (Catch) with and without proximal balloon occlusion. Fifty-six retrieval attempts were made.

Results— The proximal device allowed fast repeated application with a low risk of thromboembolic events (3%) and vasospasm, but it had a significantly lower success rate (39.4%) in retrieving thrombotic material than the distal device (DD) (82.6%; odds ratio, 7.3; 95% CI, 2.0 to 26.4). The compaction of the thrombus during retrieval with DD increased the risk of vessel wall irritation significantly (P<0.01) and complicated retrieval into the guiding catheter. The number of embolic events was significantly higher with DD (26%; odds ratio, 11.3; 95% CI, 1.35 to 101.6) unless proximal balloon occlusion was used.

Conclusions— The proximal and the distal approaches to mechanical thrombectomy proved to be effective at achieving recanalization of cranial vessels. The proximal device is faster in application and allowed repeated attempts with a low complication rate. The DD is more successful at removing thrombotic material, but its method of application and attendant thrombus compaction increase the risk of thromboembolic events and vasospasms.

Key Words: animal models • embolic stroke • interventional neuroradiology • stroke

This article has been cited by other articles:

				C. Brekenfeld, G. Schroth, M. El-Koussy, K. Nedeltchev, M. Reinert, J. Slotboom, and J. Gralla Mechanical Thromboembolectomy for Acute Ischemic Stroke: Comparison of the Catch Thromboectomy Device and the Merci Retriever In Vivo Stroke, April 1, 2008; 39(4): 1213 - 1219. [Abstract] [Full Text] [PDF]

				J. Gralla, M. Burkhardt, G. Schroth, M. El-Koussy, M. Reinert, K. Nedeltchev, J. Slotboom, and C. Brekenfeld Occlusion Length Is a Crucial Determinant of Efficiency and Complication Rate in Thrombectomy for Acute Ischemic Stroke AJNR Am. J. Neuroradiol., February 1, 2008; 29(2): 247 - 252. [Abstract] [Full Text] [PDF]

				J. Slotboom Localized therapeutic hypothermia in the brain for the treatment of ischemic stroke J Appl Physiol, April 1, 2007; 102(4): 1303 - 1304. [Full Text] [PDF]