Intra-arterial pulse wave analysis during thrombectomy for the assessment of collateral status - A feasibility study.

Abstract

Knowledge of the collateralization of an occluded vessel is important for the risk-benefit analysis of difficult revascularization maneuvers during mechanical thrombectomy. If the territory behind a clot is well perfused, one could desist from performing a risky thrombectomy maneuver. The arterial pulse pressure curve may serve as an indicator for the collateralization of an occluded target vessel. We investigated the feasibility of arterial pulse measurements with a standard microcatheter. We measured the intra-arterial blood pressure proximal and distal to the clot in 40 thrombectomy maneuvers in a porcine stroke model. We used a microcatheter (Trevo Pro 18, Stryker, Kalamazoo, CA, USA), a pressure transducer (MEMSCAP SP844), an AdInstruments Powerlab 16/35 workstation, and LabChart 8 Software (AdInstruments, Dunedin, New Zealand). Median arterial blood pressure proximal and distal to the clot was 96.0 mmHg (IQR, 23.8 mmHg) and 47.5 mmHg (IQR, 43.5 mmHg), respectively (p < .001). The median difference between systolic maximum and diastolic minimum proximal and distal to the clot decreased significantly from 1.8 mmHg (IQR, 3.6 mmHg) to 0.0 mmHg (IQR, 0.5 mmHg) (p < .001). There was loss of the curve in 26 of 40 cases and loss of pressure in 23 of 40 cases (p = .008). There was no significant correlation between vessel diameter and either loss of the pulse pressure curve (p = .20) or overall pressure loss (p = .31). It is possible to measure the pulse pressure proximal and distal to the clot with a standard microcatheter used during mechanical thrombectomy.