Aspiration Thrombectomy With and Without Intelligent Aspiration for Lower Extremity Acute Deep Vein Thrombosis

Purpose: Aspiration thrombectomy (AT) treats arterial and venous disease by removing acute thrombus but also has the potential to remove fresh blood. This retrospective analysis compares outcomes for the newly introduced Lightning 12, which uses intelligent aspiration (Penumbra, Inc.), with the continuous aspiration of CAT-8 for lower extremity acute deep vein thrombosis (DVT).

Materials and Methods: This single-center retrospective case-control study included patients undergoing VAT with Lightning 12 and age- and sex-matched patients undergoing AT with CAT-8. The primary outcome was technical success defined as greater than 70% thrombus reduction in a single session. Secondary outcomes included blood loss during aspiration, the need for postprocedure blood transfusion, tissue plasminogen activator (tPA) use, and periprocedural complications.

Results: A total of 20 patients (mean age, 59.3 years; 55.0% female) underwent AT using Lightning 12 were propensity score matched for age and gender to 30 patients (mean age, 57.8 years; 43.3% female) who underwent AT using CAT-8. Baseline demographics, medical history, procedural information, and outcomes were compared for Lightning 12 versus CAT8 and did not differ between groups with the exception of current pulmonary embolism and stenosis. Rates of adjunctive tPA use and angioplasty were lower for Lightning 12 vs CAT-8. Thrombus reduction of 70% or greater was significantly higher in the Lightning 12 group (P < 0.0001) compared with CAT8, and median blood loss was trended lower in the Lightning 12 group compared with

CAT8. There were no differences in rates of postprocedure transfusion, hematomas, or other complications.

Conclusions: Results suggest that aspiration using Lightning 12 appears safe and effective for clot removal in DVT with significant single-session technical success. In this analysis, AT using Lightning 12 was associated with significantly higher rates of technical success, less blood loss, and no need for blood transfusion.