Mechanical Thrombectomy Devices

One of the earliest and most commonly used types of clot management devices are mechanical thrombectomy systems. These employ a variety of technologies to physically capture or break up thrombi and remove them from the vasculature. Some prominent examples include stentrievers, aspiration catheters, and ultrasonic thrombectomy devices.

Stentrievers utilize a self-expanding, retrievable stent with retrievers on either end. They are delivered via a microcatheter to the location of the clot where the stent fully expands and embeds within the thrombus. When retracted, the stent and trapped clot are removed entirely from the body. Stentrievers have become a standard treatment for large vessel occlusions causing acute ischemic strokes.

Aspiration catheters employ powerful suction to lysulate and extract clots. Clot Management Devices include conventional angiographic catheters as well as specialized large bore aspiration systems. They are useful for removing both fresh and chronic thrombi from arteries and veins. Novel designs integrate aspiration with other mechanisms like maceration, rheolytic jetting, or ultrasound/laser thrombolysis to more effectively capture clots.

Ultrasonic thrombectomy devices combine irrigation and low-frequency ultrasound to emulsify blood clots. The liquefied thrombus material can then be suctioned out or passed through the device. While still investigational, early studies show promise for applications like deep venous thrombosis treatment as an alternative to pharmacological thrombolysis.

Pharmacomechanical Thrombolysis Systems

Another burgeoning area is pharmacomechanical thrombolysis which combines chemical and mechanical approaches. These systems deliver thrombolytics directly to clots while simultaneously disturbing them physically. Two such devices approved for use are the EkoSonic Endovascular System and the Indigo System.

The EkoSonic uses low-frequency ultrasound transmitted through an irrigation catheter to agitate thrombi. This enhances drug penetration and breakdown of fibrin bonds within clots. Simultaneously, pulsatile infusion drags thrombolytics into the clot fibers. Positive results have been shown for iliofemoral DVT clearance when used with tissue plasminogen activator (TPA).

The Indigo System infuses TPA through an expandable basket that itself macerates clots. Its oscillating motion shreds thrombi while maximizing drug contact. This doubles down on the lysis effects. The system has demonstrated the ability to substantially reduce clot burden in as little as 90 minutes, faster resolution than pharmacological therapy alone. Both examples illustrate advantages of integrating mechanical and pharmacological modalities for improved clot dissolution.

Get more insights on Clot Management Devices