E-015 Failure mechanisms of current thrombectomy devices identified in a human brain model: iatrogenic embolization, residual and recurrent large vessel occlusion, persistent perforating artery occlusion, and arterial collapse, traction and avulsion

• DOI: 10.1136/neurintsurg-2021-snis.111
• Publication Date: 2021-07-26T16:23:25Z
• Authors: L Savastano; D Gebrezgiabhier; J Arturo Larco; S Madhani; A Shahid; Y Liu
• Keywords: Penumbra; Embolus

<h3>Introduction</h3> Complete recanalization in large vessel occlusion (LVO) strokes with suction catheters and stent retrievers has remained at 50% despite improved technologies accumulating operator experience. About 40% of patients experience poor neurological outcomes many cannot be recanalized the first attempt. In this experimental study, we aimed to analyze interaction between arteries/emboli/devices human brains provide mechanistic explanations failures complications current interventions a brain LVO model. <h3>Method</h3> Elastic, fragment-prone stiff embolus analogs were fabricated using multilinear regression model derived from analysis emboli. Then, 105 generated 12 fresh pressurized by pulsatile pump attempted 61 cases aspiration thrombectomy (ACE™ 68; Penumbra) 44 stent/aspiration technique (Solitaire™ Platinum, Medtronic ACE™ 68, Penumbra). <h3>Results</h3> First pass complete (34%), successful (71%) (60%) rates consistent literature. Devices loaded emboli tensile forces leading elongation intravascular fragmentation downstream embolization microcirculation causing recurrent (15%) residual (73%) occlusions, or both (12%). Moreover: a) small branching perforating arteries alleged (28%); b) vacuum caused arterial collapse physiological pressures (43%); c) device withdrawal traction (41%); d) severe provoked avulsion arteries. <h3>Conclusion</h3> Stents load fragmentation, cause significant deformation, traction. <h3>Disclosures</h3> <b>L. Savastano:</b> 4; C; Endovascular Engineering. <b>D. Gebrezgiabhier:</b> None. <b>J. Arturo Larco:</b> <b>S. Madhani:</b> <b>A. Shahid:</b> <b>Y. Liu:</b> 2;