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Increased Number of Passes and Double Stent Retriever Technique Induces Cumulative Injury on Arterial Wall After Mechanical Thrombectomy in a Swine Model

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An Author Correction to this article was published on 24 June 2022

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Abstract

The number of stentriever passes during endovascular thrombectomy impacts clinical outcomes in acute ischemic stroke. Previous studies suggest that the simultaneous double stent retriever technique (DSRT) could improve the efficacy and reduce the number of passes. We aim to analyze the degree of vessel wall injury according to the number of passes and technique (single vs. simultaneous devices). Histological changes were evaluated in renal arteries (RAs) of swine models after thrombectomy (1, 2, or 3 passes) with single stent (SSRT) and DSRT. Thrombectomy passes were performed in 12 RA: 3 samples from each artery were studied by optical microscopy to assess a vascular damage score. All thirty-six samples showed endothelial denudation and different degrees of damage in the deepest layers of the arterial wall; however, all arteries remained patent by the time of assessment. In all cases, the degree of vascular injury increased with the number of passes. Compared with a SSRT, DSRT showed a higher severity of histological damage corresponding to the damage caused by 1.4 SSRT passes. However, in distal arteries, vascular damage was relatively similar when comparing SSRT with multiple passes and DSRT with one pass. The degree of vessel injury increases with the number of passes. Even though histological damage per pass was 1.4 higher with DSRT than SSRT, short-term vessel patency was not compromised after up to 3 DSRT passes. Further studies are needed to characterize the risk–benefit ratio of the DSRT in routine clinical practice.

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Authors and Affiliations

  1. Interventional Neuroradiology Section, Vall d’Hebron University Hospital, Pg Vall d’Hebron 119-129, 08035, Barcelona, Spain

    David Hernández, Manuel Requena, Carlos Piñana, Marta de Dios, Pilar Coscojuela & Alejandro Tomasello

  2. Neurosurgery and Interventional Neuroradiology, Hospital de Puerto Montt, Puerto Montt, Chile

    José Luis Cuevas

  3. Vall d’Hebron Research Institute, Vall d’Hebron University Hospital, Barcelona, Spain

    José Luis Cuevas, Marielle Esteves, Jiahui Li & Marc Ribó

  4. Department of Biomedical and Motor Sciences, University of Bologna, Bologna, Italy

    Laura Ludovica Gramegna

  5. IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy

    Laura Ludovica Gramegna

  6. Stroke Unit, Neurology, Hospital Universitari Vall d’Hebron, Barcelona, Spain

    Manuel Requena, Jiahui Li & Marc Ribó

  7. Interventional Neuroradiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain

    Alberto Gil

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  1. David Hernández
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  12. Alejandro Tomasello
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Correspondence to Alejandro Tomasello.

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Conflict of Interest

Dr. Tomasello reported receiving personal fees from Anaconda Biomed, Balt, Medtronic, Perflow, Merlin, and Stryker outside the submitted work. Dr. Ribo reported receiving personal fees from Anaconda Biomed, AptaTargets, Cerenovus, Johnson & Johnson, Medtronic, Methinks, Philips, Sanofi, Stryker, and Rapid A.I. outside the submitted work. No other disclosures were reported.

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Hernández, D., Cuevas, J.L., Gramegna, L.L. et al. Increased Number of Passes and Double Stent Retriever Technique Induces Cumulative Injury on Arterial Wall After Mechanical Thrombectomy in a Swine Model. Transl. Stroke Res. 14, 425–433 (2023). https://doi.org/10.1007/s12975-022-01044-1

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  • DOI: https://doi.org/10.1007/s12975-022-01044-1

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