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

CardioVascular and Interventional Radiology, vol. 45, pp. 112–120

Abstract

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.

Authors 8

1. Masashi Tamura Aachen Institute of Applied Medical Engineering

   RWTH Aachen University · Universitätsklinikum Aachen · Keio University

   Affiliation as printed

   Department of Radiology, Keio University School of Medicine, Tokyo, Japan

   Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University and University Hospital, Aachen, Germany

2. Sophie Bezela Aachen Institute of Applied Medical Engineering Department of Cardiovascular Engineering

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University and University Hospital, Aachen, Germany

3. Alexander Weyers Aachen Institute of Applied Medical Engineering Department of Cardiovascular Engineering

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University and University Hospital, Aachen, Germany

4. Daniel L. R. Kuetting

   University of Bonn

   Affiliation as printed

   Department of Radiology, University of Bonn, Bonn, Germany

5. Matthias F. Menne Aachen Institute of Applied Medical Engineering Department of Cardiovascular Engineering

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University and University Hospital, Aachen, Germany

6. Ulrich Steinseifer Aachen Institute of Applied Medical Engineering Department of Cardiovascular Engineering

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University and University Hospital, Aachen, Germany

7. Johanna C. Clauser Aachen Institute of Applied Medical Engineering Department of Cardiovascular Engineering

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University and University Hospital, Aachen, Germany

8. Thomas Schmitz‐Rode Aachen Institute of Applied Medical Engineering

   RWTH Aachen University · Universitätsklinikum Aachen

   Affiliation as printed

   Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University and University Hospital, Aachen, Germany