Background:
The Rotarex™ mechanical thrombectomy system has demonstrated efficient removal ofthrombus but outcomes vary across studies. We hypothesize that preoperativeanalysis of thrombus Hounsfield Unit (HU) on CT angiography may enhance patientselection and contribute to superior outcomes.
Methods:
This retrospective study analyzed 14 cases of lower extremity arterialthrombosis treated with Rotarex™ at our institution. All patients underwent CT-basedHU analysis of thrombus prior to intervention. Clinical outcomes, Rutherfordclassification, ankle-brachial index (ABI), and perioperative laboratory data(RBC, hemoglobin, total bilirubin) were evaluated.
Results:
Technical success was achieved in 100% of cases. Mean preoperative HU ofthrombus was 60.4±2.9. ABI improved significantly from 0.51±0.23 to 0.83±0.17. Rutherfordstage improved in all cases. Postoperative labvalues showed a modest decrease in RBC (–0.17±0.20×10⁶/μL), hemoglobin (–0.42±0.57g/dL), and a significant increase in total bilirubin (+0.22±0.25 mg/dL, p = 0.0138). No major complications such as distalembolization or vascular rupture occurred.
Conclusion:
HU analysis of thrombus may help select suitable candidates for mechanicalthrombectomy using Rotarex™, potentially improving technical success andminimizing complications. Our outcomes compare favorably to prior literature,supporting the integration of HU-based planning into clinical workflows.


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Methods: Thisretrospective study analyzed 14 patients with lower extremity arterialocclusion who underwent mechanical thrombectomy using Rotarex™ between March2025 to July 2025 at Pusan national university Yangsan hospital. All patientshad contrast-enhanced CT angiography prior to the procedure. As this was aretrospective study, it was exempt from IRB review.

Thrombus HU values were measured using standardized regions of interest (ROI)within the occluded vessel segments. Additional clinical data included patientdemographics, type of thrombus, in-stent vs native thrombosis, and lesionlength. The type of thrombus was classified as acute if it lasted less than 2weeks, subacute if it lasted between 2 weeks and 2 months, and chronic if itlasted more than 2 months based on the patient's history.

Procedures were performed under general anesthesia using 8F Rotarex™ device. Balloon angioplasty and adjunctive stenting were selectivelyperformed. Clinical endpoints included technical success, Rutherford stagechange, ABI, and changes in laboratory parameters (RBC, hemoglobin, totalbilirubin). 

All 14 patientsunderwent mechanical thrombectomy with the Rotarex™ system and achievedsuccessful revascularization of the target vessel, corresponding to a 100%technical success rate. Flow restoration was obtained in a single session inevery case, without the need for catheter-directed thrombolysis or opensurgical conversion.Hemodynamic andclinical indices improved consistently following the procedure. Theankle-brachial index (ABI) increased from a baseline of 0.51±0.23 to 0.83±0.17at follow-up. Rutherford stage improved in all patients, reflecting relief ofischemic symptoms and restoration of distal perfusion. No patient requiredurgent re-intervention during the index hospitalization, and there were noprocedure-related major adverse events such as access-site hemorrhage requiringtransfusion, vessel perforation requiring covered stent, or distal embolizationnecessitating secondary retrieval.Perioperativelaboratory changes were generally modest. Red blood cell count and hemoglobinlevel showed small, non-significant decreases after the procedure (RBC −0.17±0.20×10⁶/µL; hemoglobin −0.42±0.57g/dL), suggesting that clinically relevant bloodloss or hemolysis-induced anemia did not occur. Total bilirubin increased by+0.22±0.25mg/dL, which was statistically significant (p= 0.0138), consistent with mild hemolysis related to high-speed intraluminalmechanical fragmentation rather than overt hepatic dysfunction or majorhemolytic complication. No patient developed hemodynamic instability, renalfailure, or limb-threatening reperfusion injury during the in-hospital period.

Conclusion: Ourinstitutional experience demonstrates that mechanical thrombectomy withRotarex® can be highly successful when guided by HU-based thrombuscharacterization. This novel approach may improve patient selection, reduce thelikelihood of procedural failure, and offer insights into thrombus fragility.Further multicenter studies are needed to validate HU thresholds and to refineselection criteria for optimal mechanical thrombectomy candidates. Limitation.Overall, our findingssupport HU-guided patient selection as a promising strategy, but they should beconsidered hypothesis-generating; validation in larger, prospective,multi-institutional cohorts with standardized HU methodology and longerfollow-up is required before this approach can be recommended as routinepractice.