Percutaneous treatment of thrombosed arteriovenous fistulae using the Gelbfish-Endovac aspiration thrombectomy device

Abstract It is important to thoroughly remove the thrombus within the course of aspiration thrombectomy; otherwise, it may lead to further embolization. The performance of the aspiration thrombectomy device with a generic geometry is studied through the computational approach. In order to model the thrombus aspiration, a real left coronary artery is chosen while thrombi with various sizes are located at the bifurcation area of the coronary artery and, depending on the size of the thrombus, it is stretched toward the side branches. The thrombus occupies the artery resembling the blood current obstruction in the coronary vessel similar to the situation that leads to heart attack. It is concluded that the aspiration ability of the thrombectomy device is not linked to the thrombus size; it is rather linked to the aspiration pressure and thrombus age (organized versus fresh thrombus). However, the aspiration time period correlates to the thrombus size. The minimum applicable aspiration pressure is also investigated in this study.

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Comparison of Solitaire thrombectomy and Penumbra suction thrombectomy in patients with acute ischemic stroke caused by basilar artery occlusion

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2014-011472 ◽

2014 ◽

Vol 8 (1) ◽

pp. 13-18 ◽

Cited By ~ 25

Author(s):

Seungnam Son ◽

Dae Seob Choi ◽

Min Kyun Oh ◽

Jiho Hong ◽

Soo-Kyoung Kim ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Basilar Artery ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Aspiration Thrombectomy ◽

Scale Scores ◽

Thrombectomy Device ◽

Korean Food

Background and purposeAcute ischemic stroke (AIS) caused by basilar artery occlusion (BAO) is a very severe neurological disease with a high mortality rate and poor clinical outcomes. In this study, we compared our experience of mechanical thrombectomy using the Solitaire stent (Solitaire thrombectomy) and manual aspiration thrombectomy using the Penumbra reperfusion catheter (Penumbra suction thrombectomy) in patients with AIS caused by BAO.Materials and methodsBetween March 2011 and December 2011, 13 patients received Solitaire thrombectomy. In January 2012, the Korean Food and Drug Administration banned the use of the Solitaire stent as a thrombectomy device, and a further 18 patients received Penumbra suction thrombectomy until December 2013. We compared parameters between patients treated with each device.ResultsSuccessful recanalization rates (Thrombolysis in Cerebral Infarction (TICI) score ≥2b: 84.6% vs 100%, p=0.168) and clinical outcomes (judged by the modified Rankin Scale scores recorded at 3 months: 3.6±2.6 vs 3.2±2.6, p=0.726) were not significantly different between the two groups. However, complete recanalization rates (TICI score of 3: 23.1% vs 72.2%, p=0.015) and total procedure times (101.9±41.4 vs 62.3±34.8 min, p=0.044) were significantly higher, and shorter, respectively, in patients treated by Penumbra suction thrombectomy.ConclusionsThe two thrombectomy devices were associated with similar recanalization rates and clinical outcomes in patients with AIS caused by BAO. However, Penumbra suction thrombectomy seemed to allow more rapid and complete recanalization than Solitaire thrombectomy.

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Use of the Penumbra System 054 plus Low Dose Thrombolytic Infusion for Multifocal Venous Sinus Thrombosis

Interventional Neuroradiology ◽

10.1177/159101991201800311 ◽

2012 ◽

Vol 18 (3) ◽

pp. 314-319 ◽

Cited By ~ 9

Author(s):

F.M. Siddiqui ◽

G.L. Pride ◽

J.D. Lee

Keyword(s):

Mechanical Thrombectomy ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Internal Diameter ◽

Aspiration Thrombectomy ◽

Venous Sinus Thrombosis ◽

Novel Device ◽

Thrombectomy Device ◽

New Generation

Multifocal cerebral venous sinus thrombosis (CVST) has a high mortality rate especially when patients present with stupor or coma. Medical treatment including anticoagulation raises concerns about the associated high risk of intracerebral hemorrhage. Treatment of multifocal CVST with mechanical thrombectomy devices and local tPA infusion have previously been reported. However, these devices may have technical limitations. Success of the new-generation aspiration thrombectomy device like the Penumbra system has been reported in few cases of isolated CVST without the use of chemical thrombolysis. We describe two cases in which mechanical thrombectomy were used in conjunction with intra-sinus tPA infusion. Both cases were complicated and failed initial anticoagulation. Penumbra 054 was used in both cases. The Penumbra 054 is a novel device that has a bigger lumen which provides compatibility with other microcatheters, if additional therapies are required. The larger internal diameter of this catheter also allows for stronger thrombo-aspiration, potentially effecting more rapid sinus recanalization. Both cases showed remarkable clinical recovery without any major complications. This is the first reported simultaneous use of the Penumbra system 054 along with tPA infusion. New devices such as the Penumbra system may offer additional therapeutic options in the treatment of multifocal CVST.

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FlowTriever System for mechanical thromboembolectomy

Future Cardiology ◽

10.2217/fca-2020-0104 ◽

2020 ◽

Author(s):

Hamid R Mojibian ◽

Eric Chow ◽

Jeffery Pollak

Keyword(s):

Pulmonary Embolism ◽

Future Research ◽

Aspiration Thrombectomy ◽

Research Directions ◽

Risk Of Bleeding ◽

Number Of Patients ◽

Submassive Pulmonary Embolism ◽

Thrombectomy Device ◽

Future Research Directions ◽

Us Fda

The systemic or catheter-directed infusion of thrombolytics benefits patients with massive and probably submassive pulmonary embolism. However, the risk of bleeding may offset benefits in a substantial number of patients. Percutaneous mechanical thromboembolectomy is an alternative to thrombolysis in those patients with contraindications to the lytic therapy, also potentially a way to avoid systemic or catheter-directed infusion of the thrombolytic all together. The Inari FlowTriever System (Inari Medical Inc, CA, USA) is the first US FDA-cleared large-bore aspiration thrombectomy device with pulmonary embolism thrombectomy indication. This article is a review of the FlowTriever System, its clinical use, current supportive literates and future research directions.

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Effects of first pass recanalization on outcomes of contact aspiration thrombectomy

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-015221 ◽

2019 ◽

Vol 12 (5) ◽

pp. 466-470 ◽

Cited By ~ 3

Author(s):

Dong-Hun Kang ◽

Byung Moon Kim ◽

Ji Hoe Heo ◽

Hyo Suk Nam ◽

Young Dae Kim ◽

...

Keyword(s):

Clinical Outcomes ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Aspiration Thrombectomy ◽

Good Outcome ◽

Guide Catheter ◽

Rescue Treatment ◽

First Pass ◽

Thrombectomy Device ◽

Artery Disease

BackgroundFirst pass recanalization (FPR, defined as achieving a modified Thrombolysis in Cerebral Ischemia (mTICI) grade 2c/3 with a single pass of a thrombectomy device) effect has not yet been evaluated in contact aspiration thrombectomy (CAT). We evaluated FPR effect on clinical outcomes and FPR predictors in CAT.MethodsAll consecutive patients who underwent frontline CAT for anterior circulation large vessel occlusion with recanalization (mTICI 2b–3) were identified from registries at six stroke centers. The patients were dichotomized into FPR and non-FPR groups. Clinical features and outcomes were compared between the groups. Multivariate analyses were performed to determine whether FPR was independently associated with clinical outcomes and to identify predictors of FPR.ResultsOf the 429 patients who underwent frontline CAT, recanalization was successful in 344 patients (80.2%; mean age 68.7±11.0 years; M:F ratio 179:165). The FPR group had a higher rate of good outcome (modified Rankin Scale score 0–2) than the non-FPR group. Furthermore, the good outcome rate was higher in the FPR group than in patients who achieved mTICI 2c/3 with multiple passes or rescue treatment. FPR (OR 2.587; 95% CI 1.237 to 5.413) remained independently associated with good outcomes, in addition to age, baseline National Institute Health Stroke Scale, and coronary artery disease. The use of a balloon guide catheter (OR 3.071; 95% CI 1.699 to 5.550) was the only predictor of FPR.ConclusionsPatients in the FPR group had better clinical outcomes than the non-FPR group in CAT. FPR was independently associated with a good outcome. The use of a balloon guide catheter was the only predictor of FPR.

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