E-280 Technical evaluation of beveled tip aspiration compared to flat tip aspiration for acute ischemic stroke treatment. (23rd July 2022)

• Record Type: Journal Article
• Authors: Berns, H; Alyami, M; Schwartz, S; Vigil, J; Merritt, W; Ducruet, A; Becker, T
• Is Part Of: Journal of neurointerventional surgery. Volume 14(2022)Supplement 1
• Page Start: A231
• Page End: A231
• Publication Date: 2022-07-23
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2022-SNIS.391
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Introduction/Purpose: Zoom Aspiration Catheters (Imperative Care, Campbell, CA) have a unique beveled TRX Tip intended to improve clot digestion rates. The TRX Tip is angled 60-degrees, resulting in an approximate increase in surface area of 15%. Therefore, the Zoom 71 TRX Tip (0.071' ID) has the equivalent surface area of 0.076', greater than current conventional catheters tip diameters (0.064–0.074'). However, there still remains insufficient scientifical rationale why and how a 60-degree beveled tip enhances clot ingestion compared to conventional flat tip aspiration. Materials and Methods: To understand the impact of the bevel tip shape compared to the common flat-tip shape, benchtop testing was performed to analyze the mechanical properties and actions of clot ingestion using a beveled-tip aspiration catheter compared to a flat-tip aspiration catheter. Test articles were assessed with the Bioengineering Devices Laboratory (BDL) benchtop flow model at Northern Arizona University (NAU). The model consists of a programmable, hydraulic pulsatile pump system (SuperPump AR, ViVitro Labs) that simulates physiological neurovascular flows and pressures. The benchtop accommodates swappable 3D-printed circle of Willis (CW) flow models made from UV cured and acrylic-based co-polymers, which can replicate the mechanical properties of human vessels. The model also incorporates a novel and stable blood analog to mimic the viscosity and shear-thinning of blood, allowing real-time pressure and flow measurements at each CW branch. Two published synthetic blood clot analogs (soft and hard clots) was used to simulate clot aspiration. Results: To confirm aspiration effectiveness, the test articles (Zoom 88 (Z88), Zoom 71 (Z71), NeuroMax (NM), Ballast (Ball), Walrus (W-BGC), Flowgate (F-BGC), and React (R68)) were advanced to the MCA and used to remove soft and hard clot analogs. Various properties were evaluated during clot ingestion – tip geometry, catheter-to-vessel ratio (CVR), real-time pressure measurements corresponding to aspiration force, clot integration imaging, clot digestion rate into the vacuum pump, and first-pass efficiency (FPE) determined by real-time branch flow measurements. Conclusion: Preliminary data from aspiration force suggest that the beveled tip devices corresponded to greater clot integration and faster digestion rates while requiring less aspiration force. Larger-bore TRX Tip catheters, with greater CVR can also enhance clot integration and digestion rates. Therefore, improved clot integration provided by the beveled tip, can be associated with the enhanced rates of FPE, reduced procedure duration, and improved recanalization rates, compared to conventional aspiration catheters, as assessed in the benchtop flow model. Disclosures: H. Berns: 5; C; Northern Arizona University. M. Alyami: 5; C; Aneuvas Technologies Inc. S. Schwartz: 5; C; Northern Arizona University. J. Vigil: 5; C; Northern Arizona University. W. Merritt: 4; C; Aneuvas Technologies Inc (ATI). 5; C; Northern Arizona University. A. Ducruet: 2; C; Medtronic, Stryker, Penumbra, Oculus, Koswire, Cerenovus. 4; C; Aneuvas Technologies Inc (ATI). 5; C; Barrow Neurological Institute. T. Becker: 4; C; Aneuvas Technologies Inc (ATI). 5; C; Northern Arizona University. 6; C; Imperative Care.