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https://hdl.handle.net/2445/221262
Title: | Double stent-retriever as the first-line approach in mechanical thrombectomy: a randomized in vitro evaluation |
Author: | Li, Jiahui Tiberi, Riccardo Canals, Pere Vargas, Daniel Castaño Linares, Óscar Molina, Marc Tomasello, Alejandro Ribó Jacobi, Marc |
Keywords: | Trombosi Malalties cerebrovasculars Catèters Thrombosis Cerebrovascular disease Catheters |
Issue Date: | 10-Jan-2023 |
Publisher: | BMJ Publishing Group |
Abstract: | Background A repeated number of passes during mechanical thrombectomy leads to worse clinical outcomes in acute ischemic stroke. Initial experiences with the simultaneous double stent-retriever (double-SR) technique as the first-line treatment showed promising safety and efficacy results. Objective To characterize the potential benefits of using the double-SR as first-line technique as compared with the traditional single-SR approach. Methods Three types of clot analogs (soft, moderately stiff, and stiff) were used to create terminal internal carotid artery (T-ICA=44) and middle cerebral artery (MCA=88) occlusions in an in vitro neurovascular model. Sixty-six cases were randomized into each treatment arm: single-SR or double-SR, in combination with a 0.071" distal aspiration catheter. A total of 132 in vitro thrombectomies were performed. Primary endpoints were the rate of first-pass recanalization (%FPR) and procedural-related distal emboli. Results FPR was achieved in 42% of the cases. Overall, double-SR achieved a significantly higher %FPR than single-SR (52% vs 33%, P=0.035). Both techniques showed similar %FPR in T-ICA occlusions (single vs double: 23% vs 27%, P=0.728). Double-SR significantly outperformed single-SR in MCA occlusions (63% vs 38%, P=0.019), most notably in saddle occlusions (64% vs 14%, P=0.011), although no significant differences were found in single-branch occlusions (64% vs 50%, P=0.275). Double-SR reduced the maximal size of the clot fragments migrating distally (Feret diameter=1.08±0.65 mm vs 2.05±1.14 mm, P=0.038). Conclusions This randomized in vitro evaluation demonstrates that the front-line double-SR technique is more effective than single-SR in achieving FPR when treating MCA bifurcation occlusions that present saddle thrombus. |
Note: | Versió postprint del document publicat a: https://doi.org/10.1136/jnis-2022-019887 |
It is part of: | Journal of Neurointerventional Surgery, 2023 |
URI: | https://hdl.handle.net/2445/221262 |
Related resource: | https://doi.org/10.1136/jnis-2022-019887 |
ISSN: | 1759-8478 |
Appears in Collections: | Articles publicats en revistes (Enginyeria Electrònica i Biomèdica) |
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