Comparison of Aspiration Catheters with Modified Standard Catheters for Treatment of Large Pulmonary Embolism Using an In-vitro Patho-Physiological Model

• Published in: Cardiovascular and interventional radiology Vol. 45; no. 1; pp. 112 - 120
• Main Authors: Schubert, Franziska, Tamura, Masashi, Bezela, Sophie, Weyers, Alexander, Kütting, Daniel, Menne, Matthias, Steinseifer, Ulrich, Clauser, Johanna C., Schmitz-Rode, Thomas
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.01.2022; Springer Nature B.V
• Subjects: Animals; Arterial Interventions; Balloon catheters; Blood clots; Cardiology; Catheters; Embolism; Embolisms; Fragmentation; Imaging; Laboratory Investigation; Medical instruments; Medicine; Medicine & Public Health; Nuclear Medicine; Physiology; Pulmonary arteries; Pulmonary Artery; Pulmonary Embolism - therapy; Pulmonary embolisms; Radiology; Swine; Thrombectomy; Thrombosis; Treatment Outcome; Ultrasound; Pulmonary embolism; Patho-physiological model; Interventional radiology; Mechanical thrombectomy; Aspiration; Comparative in-vitro study; Fragmentation
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-021-02987-y

Purpose The presented in-vitro study provides a comparison of various catheters for mechanical treatment of large-burden pulmonary embolism (PE) under standardized conditions, using a new test rig. Dedicated aspiration catheters (JETi®, Penumbra Indigo®, Aspirex®) were compared with standard catheters (Pigtail, Multi-Purpose, Balloon Catheter) applied for embolus fragmentation. Materials and Methods Emboli prepared from porcine blood were washed into the test rig which consists of anatomical models of the pulmonary artery (PA) and of the right heart in combination with a pulsatile drive system. For all catheters, the duration of the recanalization procedure and the weight percentage (wt%) of the remaining, removed and washed-down clot fractions were evaluated. For aspiration catheters, the aspirated volume was measured. Results All catheters achieved full or partial recanalization. The aspiration catheters showed a significantly (p < 0.05) lower procedure time (3:15 min ± 4:26 min) than the standard fragmentation catheters (7:19 min ± 4:40 min). The amount of thrombus removed by aspiration was significantly (p < 0.001) higher than that by fragmentation, averaging 86.1 wt% ± 15.6 wt% and 31.7 wt% ± 3.8 wt%, respectively. Nonetheless, most of the residue was fragmented into pieces of ≥ 1 mm and washed down. Only in 2 of 36 tests, a residual thrombus of 11.9 wt% ± 5.1 wt% remained in the central PA. Conclusion Comparison under standardized in-vitro patho-physiological conditions showed that embolus fragmentation with standard catheters is clearly inferior to aspiration with dedicated catheters in the treatment of large-burden PE, but can still achieve considerable success. Level of Evidence No level of evidence, experimental study.