Abstract
BACKGROUND AND PURPOSE: The persistent challenges in thrombectomy for large-vessel occlusion, such as suboptimal complete recanalization and first-pass effect imply an insufficient understanding of the artery-clot-device interaction. In this study, we present a thrombectomy model using fresh human brains, which can capture the artery-clot-device interaction through concurrent transmural and angiographic visualizations.
MATERIALS AND METHODS: Fresh nonfrozen whole adult human brains were collected and connected to a customized pump system tuned to deliver saline flow at a physiologic flow rate and pressure. Angiography was performed to verify the flow in the anterior-posterior and vertebrobasilar circulations and collaterals. Large-vessel occlusion was simulated by embolizing a radiopaque clot analog. Thrombectomy was tested, and the artery-clot-device interactions were recorded by transmural and angiographic videos.
RESULTS: Baseline cerebral angiography revealed excellent penetration of contrast in the anterior-posterior and vertebrobasilar circulations without notable arterial cutoffs and with robust collaterals. Small branches (<0.5 mm) and perforating arteries were consistently opacified with good patency. Three device passes were performed to achieve recanalization, with failure modes including elongation, fragmentation, and distal embolization.
CONCLUSIONS: This model enables concurrent transmural and angiographic analysis of artery-clot-device interaction in a human brain and provides critical insights into the action mechanism and failure modes of current and upcoming thrombectomy devices.
ABBREVIATIONS:
- LVO
- large-vessel occlusion
- VA
- vertebral artery
Footnotes
Disclosures: Yang Liu—UNRELATED: Stock/Stock Options: Endovascular Engineering. Ram Kadirvel—RELATED: Grant: National Institutes of Health, Comments: National Institutes of Health NS076491.* David F. Kallmes—UNRELATED: Board Membership: Triticum,* Comments: Advisory Board; Consultancy: NoNO, Vesalio, Minnetronix,* Comments: Data and Safety Monitoring Board; Grants/Grants Pending: Balt, MicroVention, Medtronic, Neurogami, Monarch Medical, Insera Therapeutics, MIVI Neurovascular,* Comments: research support; Patents (Planned, Pending, or Issued): Balloon-Guide technology, Spine Augmentation technology*; Royalties: Balloon Guide Technology; Stock/Stock Options: Marblehead Medical, Conway Medical Center, Superior Medical Experts. Luis E. Savastano—UNRELATED: Board Membership: President of Endovascular Engineering; Employment: Chief Medical Officer of VerAvanti; Stock/Stock Options: VerAvanti and Endovascular Engineering. *Money paid to the institution.
This work was supported by the National Institutes of Health National Institute of Neurological Disorders and Stroke (NS105853).
- © 2021 by American Journal of Neuroradiology
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