Catheter-Vessel Interactions During Aspiration Thrombectomy: A Comprehensive Analysis Using a Novel Swine Model

BACKGROUND AND PURPOSE: Catheter-vessel interactions during aspiration thrombectomy may vary depending on vessel size, potentially affecting reperfusion outcomes. This study aimed to assess how vessel diameter influences procedural dynamics and reperfusion success rates using a swine model with real-time, direct vessel visualization.

MATERIALS AND METHODS: An animal model utilizing Yorkshire swine was used to evaluate catheter-vessel interactions during aspiration thrombectomy. The common carotid artery (CCA, 4–6 mm) and superficial cervical artery (SCA, 2–3 mm) represented large and small vessels, respectively. Each vessel was surgically exposed, occluded using clot analogs, and monitored using a high-resolution digital microscope camera. Aspiration thrombectomy was performed starting with remote aspiration, followed by contact aspiration. Vessel behavior, including collapse and traction, was evaluated in relation to vessel size and reperfusion success.

RESULTS: A total of 33 thrombectomy procedures were performed on 14 vessels in 4 swine. In the CCA group (mean diameter: 5.14 mm), remote aspiration achieved 85.7% reperfusion success without vessel collapse, leading to 100% final reperfusion. In the SCA group (mean diameter: 2.27 mm), all remote aspiration attempts caused immediate vessel collapse with no successful reperfusion (0%), requiring contact aspiration, which resulted in 71.4% final reperfusion. Vessel collapse was significantly more frequent in SCA vs. CCA (p < 0.001). Two distinct patterns of vessel traction were observed exclusively in the SCA group.

CONCLUSIONS: Vessel size strongly influences aspiration thrombectomy efficacy. Smaller vessels are more susceptible to vessel collapse and catheter-induced traction during aspiration thrombectomy, reducing the success rate of reperfusion and increasing reliance on true contact aspiration.

ABBREVIATIONS: CCA＝ common carotid artery; SCA＝ superficial cervical artery; LVO＝ large-vessel occlusion.