046 Influence of diameter on total thrombectomy with the Export catheter: A laboratory bench study: smaller is better?

Abstract

Recent studies have shown that thrombectomy improves myocardial reperfusion and outcomes, and reduces infarct size by removing the clot and/or limiting distal embolization. However, in practice, the results of thrombectomy are not always optimal. The aim of this laboratory bench study was to evaluate the impact of diameters, angles and thrombus age on the success of thrombectomy. The test apparatus consisted of glass tubes of 150 mm in length with 5 different diameters: 2.0, 2.6, 3.0, 3.6 and 4 mm. For each diameter, 3 angles were tested: 0°, 90° or 120° and 2 ages of thrombi: 3 or 6 hours old. We used human blood drawn from healthy volunteers, who had received neither antiplatelet nor anticoagulation therapy. Thrombectomy was performed with an Export catheter (Medtronic ® ) and the main assessment criterion was total thrombectomy (TT). Total thrombectomy was achieved in 71.2% of tests. TT was obtained only for small diameter tubes (2 mm) and we observed a significant reduction in aspiration with increasing diameter, respectively, 100% for 2.0 mm, 81.3% for 2.6 mm, 89.6% for 3.0, 54.2% for 3.6 mm and 31.3% for 4 mm tubes, (p<0.001). In contrast no difference was observed between 3-hour-old (73.3%) and 6-hour-old thrombi (69.2%) (p = 0.476). In addition, the presence of one angle did not influence the success of thrombectomy either: 77.5% in 0°, 66.3% in 90° and 70% in 120° tubes (p = 0.278). In the laboratory, tube diameter was a major factor that influenced the quantity of thrombus removed. With this new data, further studies are needed to evaluate: a) the modalities of the aspiration, b) the impact of other catheters, c) and the characteristics of the artery and lesion.