Experimental evaluation of the plunger technique: A method of cyclic manual aspiration thrombectomy for treatment of acute ischemic stroke

Author:

Poulos Demitria A1,Keith James S1,Froehler Michael T2ORCID,Good Bryan C1ORCID

Affiliation:

1. Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Knoxville, TN, USA

2. Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, TN, USA

Abstract

Background Mechanical thrombectomy via direct aspiration is a rapid treatment for acute ischemic stroke. This method often results in the partial ingestion of the clot or “corking” of the catheter tip. Cyclic aspiration may take advantage of the mechanical properties of the clot, resulting in greater clot ingestion and overall procedure success. Methods An in vitro analysis was performed comparing static and cyclic (plunger technique) aspiration. Embolus analogs were used to create occlusions in a mock circulatory flow loop, and one aspiration attempt (first pass effect) using either a static or plunger technique was performed. The percent ingestion of each embolus analog was recorded for each trial. Results Static aspiration for 0% and 50% hematocrit embolus analogs resulted in ingestions of 12.8 ± 4.6% and 15.1 ± 10.0%, respectively, while plunger technique (cyclic) aspiration resulted in 15.8 ± 7.3% and 34.4 ± 19.5% ingestion. Complete ingestion was observed only with 50% hematocrit analogs, occurring in 30% of plunger and 10% of static cases. Statistical differences were determined between the two aspiration techniques for the 50% hematocrit samples, with the plunger technique yielding significantly more ingestion. In addition, the plunger technique was shown to maintain a negative vacuum pressure throughout the duration of cyclic plunging. Conclusions The plunger technique for manual cyclic aspiration resulted in higher rates of complete ingestion and greater average % ingestions when compared to static aspiration. Increased clot ingestion can result in a higher rate of complete reperfusion during the first aspiration attempt, maximizing the number of patients with good clinical outcomes.

Publisher

SAGE Publications

Cited by 2 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Plunge with caution: safeguarding patients in mechanical thrombectomy;Journal of NeuroInterventional Surgery;2024-04-09

2. Response to ‘plunge with caution: safeguarding patients in mechanical thrombectomy’;Journal of NeuroInterventional Surgery;2024-04-09

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