Published Online
on October 19, 2006

A more recent version of this article appeared on December 1, 2006

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Submitted on January 17, 2006
Revised on April 13, 2006
Accepted on April 28, 2006

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; and 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.

^* To whom correspondence should be addressed. 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

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