Research Article| Volume 32, ISSUE 3, 106948, March 2023

Modification by an aspiration catheter for vessel stretching in thrombectomy using a stent retriever in vitro


      • CBT can decrease M2 stretching when an SR is distally deployed and retrieved.
      • Distal SR deployment without an AC enhances M2 vessel stretching.
      • Modifying vessel stretching may contribute to reduced PTSAH after EVT using an SR.



      Post-thrombectomy subarachnoid hemorrhage, which is caused by vessel stretching when retrieving a stent retriever (SR), is a complication of endovascular mechanical thrombectomy (EVT) using an SR. This in vitro study examined the association between EVT for middle cerebral artery (MCA) occlusion and M2 vessel stretching depending on the positioning of the SR or combined use of SR and aspiration catheter (AC) technique (CBT).

      Materials and methods

      A silicone vascular model was used. The maximum migration distance (MMD) in the anteroposterior view of an X-ray impermeable metal marker located at an M2 trunk 20 mm distal to the M1-2 bifurcation in angiographic images during an SR retrieval was calculated. According to the positioning of SR deployment (distal or proximal) and use of an AC [SR alone without an AC (SR alone) group, stent retrieval into an AC (SA) group, and stent-AC retrieval as a unit into a guiding catheter (SA unit) group], 60 attempts were conducted with each group of 10 attempts.


      In distal SR deployment, the MMD in the CBT group, consisting of SA and SA unit groups, was significantly smaller than the SR alone group (1.36 ± 0.32 mm VS 2.39 ± 1.10 mm; p = 0.001). In proximal SR deployment, the CBT group showed a tendency to decrease MMD (1.38 ± 0.33 mm VS 1.63 ± 0.28 mm; p = 0.077).


      This in vitro study showed that CBT might help modify the stretching of M2 when an SR is distally deployed in MCA occlusion.

      Key Words


      AC (aspiration catheter), ADAPT (a direct aspiration first-pass technique), AIS (acute ischemic stroke), A-P (anteroposterior), ASAP (a stent-retrieving into an aspiration catheter with proximal balloon), BGC (balloon guiding catheter), CAPTIVE (continuous aspiration prior to intracranial vascular embolectomy), CBT (combined use of a stent retriever and aspiration catheter technique), EVT (endovascular mechanical thrombectomy), FPE (first-pass effect), ICA (internal carotid artery), MCA (middle cerebral artery), MMD (maximum migration distance), mTICI (modified Thrombolysis In Cerebral Infarction), PTSAH (post-thrombectomy subarachnoid hemorrhage), SA (stent-retrieving into an aspiration catheter), SA unit (stent-aspiration catheter retrieving as a unit into a guiding catheter), SR (stent retriever), SR alone (stent retriever alone without an aspiration catheter)
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