Aspiration technology: it’s not just about luminal diameter, although diameter is the most important!
As mentioned in a previous analysis – first-line aspiration technology is rapidly evolving and provides promising first-pass effect rates of 70-80%[1,2]. These improvements are expected to be available for routine clinical use in the following years. They are mainly obtained by increasing the device’s size, which provides subsequent, direct improvements in aspiration force and facilitates complete clot ingestion, thereby limiting distal emboli. However, several other enhancements may involve “aspiration” making future pump aspiration much more efficacious than it is now.
Future aspiration force improvements:
The technological evolution driving acute ischemic stroke reperfusion therapies is extraordinary and unprecedented in the field of neurointervention. While we are not there yet – future aspiration technology promises 70% first pass effect as compared to less than 40% with currently available devices. Due to its simplicity and provided its cost will further decrease – we might expect a thrombectomy revolution to be implemented world-wide with no discrepancy between developed and less developed countries.
1. Fitzgerald S, Ryan D, Thornton J, et al. Preclinical evaluation of Millipede 088 intracranial aspiration catheter in cadaver and in vitro thrombectomy models. J Neurointerv Surg 2021;13:447–52. doi:10.1136/neurintsurg-2020-016218
2. Caldwell J, McGuinness B, Lee SS, et al. Aspiration thrombectomy using a novel 088 catheter and specialized delivery catheter. J Neurointerv Surg 2022;14:1239–43. doi:10.1136/neurintsurg-2021-018318
3. Gross BA, Jadhav AP, Jovin TG, et al. Dump the pump: Manual aspiration thrombectomy (MAT) with a syringe is technically effective, expeditious, and cost-efficient. J Neurointerv Surg 2018;10:354–7. doi:10.1136/neurintsurg-2017-013520
4. Kalousek V, Yoo AJ, Sheth SA, et al. Cyclical aspiration using a novel mechanical thrombectomy device is associated with a high TICI 3 first pass effect in large‐vessel strokes. Journal of Neuroimaging 2021;31:912–24. doi:10.1111/jon.12889
5. Arslanian RA, Marosfoi M, Caroff J, et al. Complete clot ingestion with cyclical ADAPT increases first-pass recanalization and reduces distal embolization. J Neurointerv Surg 2019;11:931–6. doi:10.1136/neurintsurg-2018-014625
6. Marosfoi M, Strittmatter L, Arslanian R, et al. E-112 How do clots respond to direct aspiration during interventional treatment of acute ischemic stroke. In: Journal of NeuroInterventional Surgery. BMJ 2019. A109.2-A110. doi:10.1136/neurintsurg-2019-snis.187
7. Kothari S, Morsi RZ, Thind S, et al. Endovascular thrombectomy for cerebral venous sinus thrombosis using the Penumbra Indigo ® Aspiration System. Interventional Neuroradiology 2023;:159101992311526. doi:10.1177/15910199231152692
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