Abstract 005: In vitro evaluation of a novel peristaltic pump for mechanical thrombectomy

Introduction Aspiration thrombectomy is a widely accepted frontline treatment for large vessel occlusions in acute ischemic stroke. While revascularization rates have improved with advancements in catheter technology, innovation in aspiration pumps has been limited. The ALGO Smart Pump (Von Vascular, Sunrise, FL) is a sterile, miniaturized, on‐field, operator‐driven peristaltic pump offering two aspiration modes: Adaptive Pulsatile Aspiration (APA™) Mode and a continuous ‘Static’ mode. Compared to traditional aspiration pumps, where negative pressure is applied in an abrupt step‐change, the ALGO Smart pump creates negative pressure via a peristaltic mechanism that allows for incremental increase in vacuum force, potentially allowing for a more controlled and complete ingestion of clot and avoidance of “corking” and resultant microemboli on catheter withdrawal. This study evaluates the performance of the ALGO Smart Pump in Static Mode compared to a commercially available aspiration pump. Methods A pulsatile flow bench model was used with a silicone replica of the middle cerebral artery to simulate thrombectomy conditions. Synthetic clots were positioned in the model and operators performed aspiration thrombectomy with ALGO and with the Penumbra ENGINE (Penumbra, Alameda, CA) using a combination of large bore and medium bore aspiration catheters. Primary endpoint was complete clot ingestion (CCI) into the pump reservoir. Complete clot ingestion, without “corking” of clot in the catheter tip, has been demonstrated to be associated with smaller and fewer distal emboli and higher rates of first pass recanalization (1). Secondary endpoints included first pass recanalization, embolization to new territories (ENT) and total aspiration time. Results In 180 thrombectomies evaluating large bore catheters, ALGO achieved a CCI rate of 93.3% and ENGINE achieved 87.8% (p =.30). Time to clot clearance was not significantly different between groups (p =.11). In 180 thrombectomies evaluating medium bore catheters, ALGO demonstrated a higher CCI rate than ENGINE (77.8% versus 63.3%, p =.048). Time to clot clearance was not significantly different between groups (p =.74). In all 360 thrombectomies, the synthetic clot was completely removed from the vasculature in one pass without evidence of ENT. Conclusion The ALGO Smart Pump in static mode is highly effective in achieving complete clot ingestion, with similar rates of CCI compared to the Penumbra ENGINE in large bore catheters and higher rates of CCI in medium bore catheters. The ALGO Smart Pump may represent a reliable alternative in mechanical thrombectomy compared to existing commercially available aspiration pumps with additional user friendly benefits including a sterile, on‐field apparatus that can be driven by the operator without need for off‐field assistance and a simple to navigate graphical user interface with clear operating instructions. Further research is required to understand how the peristaltic slow rise of negative pressure contributes to improved rates of CCI in medium bore catheters.