Validation of an in vitro testing platform for intra-arterial thrombolytics on human thrombectomy retrieved clots.

Background: Endovascular thrombectomy (EVT) is the standard treatment for acute ischemic stroke (AIS) due to large vessel occlusion. However, many patients fail to achieve good outcomes, especially without first pass reperfusion. Intra-arterial thrombolytics such as recombinant tissue plasminogen activator (rtPA) and tirofiban have shown potential as adjunctive therapies.

Association of initial core volume on non-contrast CT using a deep learning algorithm with clinical outcomes in acute ischemic stroke: a potential tool for selection and prognosis?

Background: In an extended time window, contrast-based neuroimaging is valuable for treatment selection or prognosis in patients with stroke undergoing reperfusion treatment. However, its immediate availability remains limited, especially in resource-constrained regions. We sought to evaluate the association of initial core volume (ICV) measured on non-contrast computed tomography (NCCT) by a deep learning-based algorithm with outcomes in patients undergoing reperfusion treatment.

Prognostic value of intracranial vascular tortuosity in thrombectomy for distal vessel occlusion.

Introduction: Neutral results from trials assessing mechanical thrombectomy (MT) for medium/distal vessel occlusions (MDVO) suggest the need for better selection criteria in these patients. Tortuous vascular anatomies may negatively influence MT efficacy and safety.

Patients And Methods: Consecutive patients with middle cerebral artery (MCA)-MDVO (M2/M3) who underwent MT at our center between January 2017 and September 2024 were included.

Multimodal deep learning for predicting unsuccessful recanalization in refractory large vessel occlusion.

Purpose: This study explores a multi-modal deep learning approach that integrates pre-intervention neuroimaging and clinical data to predict endovascular therapy (EVT) outcomes in acute ischemic stroke patients. To this end, consecutive stroke patients undergoing EVT were included in the study, including patients with suspected Intracranial Atherosclerosis-related Large Vessel Occlusion ICAD-LVO and other refractory occlusions.

Methods: A retrospective, single-center cohort of patients with anterior circulation LVO who underwent EVT between 2017-2023 was analyzed.

Deep learning-based model for difficult transfemoral access prediction compared with human assessment in stroke thrombectomy.

Background: In mechanical thrombectomy (MT), extracranial vascular tortuosity is among the main determinants of procedure duration and success. Currently, no rapid and reliable method exists to identify the anatomical features precluding fast and stable access to the cervical vessels.

Methods: A retrospective sample of 513 patients were included in this study.

Partial (SAVE) versus Complete (Solumbra) Stent Retriever Retraction Technique for Mechanical Thrombectomy: A Randomized In Vitro Study.

Background And Purpose: Mechanical thrombectomy has become a first-line treatment for acute ischemic stroke. Several techniques combining stent retrievers and distal aspiration catheters have been described. We aimed to characterize the efficacy of 2 commonly used techniques according to clot characteristics.

Impact on collateral flow of devices used for endovascular treatment of stroke: an in-vitro flow model.

Background: Collateral blood supply of distal vessels has been linked to clinical outcome, infarct volume and recanalization rates in patients with large vessel occlusion. Our study aimed to explore the effects of catheterization during mechanical thrombectomy in collaterals.

Methods: We quantified the flow diversion effect secondary to arterial occlusions in an in vitro model which was connected in a flow-loop setup with a saline reservoir and a pump supplying pulsatile flow.

Double stent-retriever as the first-line approach in mechanical thrombectomy: a randomized in vitro evaluation.

Background: A repeated number of passes during mechanical thrombectomy leads to worse clinical outcomes in acute ischemic stroke. Initial experiences with the simultaneous double stent-retriever (double-SR) technique as the first-line treatment showed promising safety and efficacy results.

Objective: To characterize the potential benefits of using the double-SR as first-line technique as compared with the traditional single-SR approach.

Trackability of distal access catheters: an in vitro quantitative evaluation of navigation strategies.

Background: In mechanical thrombectomy (MT), distal access catheters (DACs) are tracked through the vascular anatomy to reach the occlusion site. The inability of DACs to reach the occlusion site has been reported as a predictor of unsuccessful recanalization. This study aims to provide insight into how to navigate devices through the vascular anatomy with minimal track forces, since higher forces may imply more risk of vascular injuries.

Catheter tip distensibility substantially influences the aspiration force of thrombectomy devices.

Background: A direct aspiration first pass thrombectomy (ADAPT) is a fast-growing technique for which a broad catalog of catheters that provide a wide range of aspiration forces can be used. We aimed to characterize different catheters' aspiration performance on stiff clots in an in vitro vascular model. We hypothesized that labeled catheter inner diameter (labeled-ID) is not the only parameter that affects the aspiration force (asp-F) and that thrombus-catheter tip interaction and distensibility also play a major role.