Clinical Application Of Hydrodynamic Thrombectomy And Comparison In Vitro Study Of Related Devices

Purpose: To evaluate the efficacy and safety of hydrodynamic thrombectomy fortreatment of occlusions of peripheral arteries and deep venous. To provide the reference of choice of devices for clinical application through comparing four hydrodynamic thrombectomy catheters(6FN 8F Oasis, 6F^ 7F Hydrolyser ) in vitro flow models of different inner tube diameter.Material and Methods: 1 Clinical Application Twenty patients with occludedarteries and 17 patients with deep vein thrombosis within 1 week were treated with hydrodynamic thrombectomy catheter. The revascularization and clinical efficacy and complications were observed. 2 Vitro Study Thrombectomy of clots from 3-day-old porcine blood was performed with the hydrodynamic thrombectomy catheters(6F, 8F Oasis, 6F> 7F Hydrolyser ) in vitro flow models of different inner tube diameter (6mirK 8mm , 10mnu 12mm, 15mm) .The efficacy of clot removal and the amount of applied saline and aspirated fluid and the procedure-related rate of embolism for the four catheters were compared.Results : 1 Clinical Application In the group of occluded arteries, afterhydrodynamic thrombectomy, the majority of thrombus material was removed and antegrade blood flow was reestablished in 19(95%) patients. Technical success (residual luminal narrowing < 50%) was 85% (17/20). Complications related to hydrodynamic thrombectomy were one (5%) distal embolization and one (5%) dissection. In the group of deep vein thrombosis, the majority of thrombus material was removed and antegrade blood flow was reestablished in all patients. Technical success (residual luminal narrowing < 50%) was 100%. None of severe complications related to hydrodynamic thrombectomy occurred. 2 Vitro Study In the flow model of 6 mm inner tube diameter, mean rate of embolism for 6F Oasis was the lowest(p<0.01). Compared with 6F Hydrolyser, mean time of thrombectomy was shorter and applied saline was smaller for 6F Oasis (p<0.01)but the same as the othertwo catheters(p>0.05). In the flow model of 8 mm, compared with 6F Hydrolyser and 6F Oasis, mean time of thrombectomy was shorter and applied saline was smaller for 8F Oasis (p<0.01). Mean rate of embolism for 8F Oasis was lower than 7F Hydrolyser (p<0.01) but the same as the other two catheters(p>0.05). In the flow models of 10 mm and 12mm, compared with 6F Hydrolyser and 6F Oasis, mean time of thrombectomy were shorter and applied saline were smaller for for 8F Oasis and 7F Hydrolyser (p<0.01). In the flow model of 15 mm inner tube diameter, compared with 8F Oasis, mean time of thrombectomy was shorter and rate of thrombectomy was higher for 7F Hydrolyser (p<0.05).Conclusion: 1, The hydrodynamic thrombectomy appears to be safe and effective for rapid thrombectomy of acute or subacute thrombus. 2 , Efficiency of thrombectomy and complications related to hydrodynamic thrombectomy depend on the devices chosen according to inner tube diameter of blood vessel. In vitro,the most appropriate devices for rapid mechanical thrombectomy seems to be 6F Oasis in the flow model of 6 mm inner tube diameter, 8F Oasis in the flow model of 8 mm , 8F Oasis and 7F Hydrolyser in the flow models of 10 mm and 12mm, 7F Hydrolyser in the flow model of 15 mm.