Introduction: Utilization of a Balloon-guide catheter (BGC) or focal aspiration during mechanical thrombectomy continues to be areas of discussion. The aim of this study was to compare the effects of these two techniques on middle cerebral artery (MCA) blood flow.
Methods: Utilizing a bench top anterior circulation flow model, the effects of a balloon-guide catheter and focal aspiration catheter on flow were determined. Models were constructed with two different MCA diameters, 3mm and 4mm, respectively. Baseline flow rates were established in 3mm and 4mm MCA vessels to be 152ml/min, with 15 mL/min originating from the posterior communicating artery (PCOM); 50 mL/min from the anterior communicating artery (ACOM); and 85 mL/min from the internal carotid artery (ICA). MCA flow was then measured with a Penumbra ACE68 reperfusion catheter placed in the MCA and attached to a Penumbra Pump MAX or a Stryker Flowgate balloon guide catheter (BGC) inflated within the ICA.
Results: Utilization of BGC inflation resulted in flow arrest in an isolated carotid artery. However, use of a BGC had little impact on collateral flow from the PCOM or ACOM. Flow within the MCA measured 16 ml/min with a patent PCOM and ICA; 50 ml/min with ACOM and ICA flow; and 65 ml/min with PCOM, ACOM, and ICA flow. In the highest flow condition when all vessels (PCOM + ACOM + ICA) are patent, ACE68 with pump aspiration provided complete flow reversal.
Conclusions: In the presence of a complete or partial Circle-of-Willis, focal aspiration provides a greater reduction in flow and theoretically a reduced risk of distal emboli compared to BGC. These results may shed light on the future directions for techniques aimed at reducing distal emboli.
Patient Care: New technique on the effects of these two techniques on middle cerebral artery (MCA) blood flow.
Learning Objectives: ACE 68 under full vacuum completely stops flow in the MCA. An inflated Flowgate will only stop flow if there is no PCOM or ACOM cross flow. If either of these vessels is present, MCA flow is significant even with the balloon inflated.