EP64 Systematic review and analysis of pre-clinical side-by-side comparisons of EmboTrap versus Solitaire performance

Introduction

The first pass effect (FPE) has gained acceptance as the new measure of success for mechanical thrombectomy. Lacking clinical trials that compare devices, in-vitro studies may be useful to investigate the impact of device designs to FPE.

Aim of the Study

To systematically compare EmboTrap performance using side-by-side generated in-vitro comparative studies

Methods

A systematic review of literature for pre-clinical data containing in-vitro thrombectomies was performed in Pubmed. Articles were included if multiple devices including EmboTrap were used in the same models, techniques, and blood clot analogs. Individualized data were extracted, and a pooled analysis was performed. Comparisons of recanalization success between stent-retrievers and different clot types were performed using two-way analysis of variance (ANOVA) and a two-sample t-test with Tukey’s honestly significance.

Results

An initial search revealed 277 articles, 4 articles met the inclusion criteria. Only EmboTrap and Solitaire devices were consistently used in all 4 articles, limiting comparisons to only these two devices. Three articles described outcomes as first-pass complete clot removal, while one article allowed up to 3 passes, for a total of 210 thrombectomy attempts. Of the three clot types studied, friable and tough clots were recanalized less effectively than standard clots (p<0.01), but not different from each other (p>0.05). EmboTrap had better recanalization outcomes than Solitaire (p<0.01), particularly observed for friable (p<0.05) and standard (p<0.05) clots, but not for tough clots (p>0.05).

Conclusions

Pre-clinical data, particularly from combined independent studies, can provide insightful comparisons between device designs.

References

Machi P, Jourdan F, Ambard D, et al. Experimental evaluation of stent retrievers´ mechanical properties and effectiveness. J Neurointerv Surg 2017 Mar;9(3):257–263. Chueh JY, Marosfoi MG, Brooks OW, et al. Novel distal emboli protection technology: the EmboTrap. Interv Neurol 2017 Oct;6(3–4):268–276. Kaneko N, Komuro Y, Yokota H, et al. Stent retrievers with segmented design improve the efficacy of thrombectomy in tortuous vessels. J Neurointerv Surg 2019 Feb;11(2):119–122. Soize S, Pierot L, Mirza M, et al. Fast stent retrieval improves recanalization rates of thrombectomy: experimental study on different thrombi. AJNR Am J Neuroradiol 2020 Jun;41(6):1049–1053.

Disclosure

MM, RM, and MG are employees of Cerenovus.