Use of a novel, non-continuous aspiration pump during mechanical thrombectomy: An in vitro study.

Abstract

BackgroundAspiration thrombectomy has become a standard tool for clot extraction in ischemic stroke. The ALGO Smart Pump (Von Vascular, Sunrise, FL) utilizes novel non-continuous aspiration and real-time objective data with the intent of increasing clot ingestion and first-pass effect while reducing distal emboli and time to reperfusion.MethodsFive different catheters were used to test clot extraction with the ALGO pump in a Mentice flow model. Clot extraction time, clot length, clot lodging or "corking" within the catheter, first-pass effect, distal embolization, and catheter distortion were assessed for each thrombectomy procedure. Thirty thrombectomies were performed with each catheter for a total of 150 thrombectomies.ResultsAll trials achieved reperfusion on the first pass. Complete clot ingestion with resumption of free flow through the catheter was seen in 65.3% of trials, with the remainder involving corking of the clot in the catheter or at the catheter tip. When the clot became corked, 63.3% of the time it was corked completely within the catheter; in the other 36.7%, the clot was corked at the catheter tip. Distal emboli were seen in 3.3% of trials. No evidence of catheter distortion was observed.Discussion/ConclusionThe ALGO non-continuous aspiration pump is effective at clot extraction with a wide range of catheters in the in vitro model. The low incidence of catheter tip-corking and distal emboli as well as the high first-pass reperfusion rate suggests the possibility of improved reperfusion with non-continuous aspiration.