Numerical modelling of blood clot extraction by aspiration thrombectomy. Evaluation of aspiration catheter geometry

Talayero, Carlos; Romero, Gregorio; Pearce, Gillian; Wong, John

doi:10.1016/j.jbiomech.2019.07.033

Cited by 11 publications

(19 citation statements)

References 12 publications

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“…In vitro studies have investigated the mechanical behaviour and functioning of devices [17] and clots [18], and the stent-clot interaction [19,20]. In the few published in silico studies [21,22], the procedure was modelled as an electric circuit analogue and the clot as a spring-damper system, ignoring the mechanical nature of the stent-clot interaction.…”

Section: Introductionmentioning

confidence: 99%

Applicability assessment of a stent-retriever thrombectomy finite-element model

et al. 2020

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An acute ischaemic stroke appears when a blood clot blocks the blood flow in a cerebral artery. Intra-arterial thrombectomy, a mini-invasive procedure based on stent technology, is a mechanical available treatment to extract the clot and restore the blood circulation. After stent deployment, the clot, trapped in the stent struts, is pulled along with the stent towards a receiving catheter. Recent clinical trials have confirmed the effectiveness and safety of mechanical thrombectomy. However, the procedure requires further investigation. The aim of this study is the development of a numerical finite-element-based model of the thrombectomy procedure. In vitro thrombectomy tests are performed in different vessel geometries and one simulation for each test is carried out to verify the accuracy and reliability of the proposed numerical model. The results of the simulations confirm the efficacy of the model to replicate all the experimental setups. Clot stress and strain fields from the numerical analysis, which vary depending on the geometric features of the vessel, could be used to evaluate the possible fragmentation of the clot during the procedure. The proposed in vitro / in silico comparison aims at assessing the applicability of the numerical model and at providing validation evidence for the specific in vivo thrombectomy outcomes prediction.

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Section: Introductionmentioning

confidence: 99%

Applicability assessment of a stent-retriever thrombectomy finite-element model

et al. 2020

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“…In this context, several previous numerical studies on aspiration have modeled the arterial wall as rigid [7, 14, 35, 42]. The Romero and Talayero groups have used a simplified, linear elastic model for the artery [38–41, 46, 47]. For the current study, we have used the nonlinear hyperelastic model in [21], which was also used in our previous study, [34].…”

Section: Discussionmentioning

confidence: 99%

“…In order to better understand the limitations posed by aspiration thrombectomy, and to develop more effective first pass strategies for the retrieval of long clots, it is essential to study the underlying mechanics of the clot and the clot-artery surface interactions during the procedure. In this regard, very few groups have developed numerical models for aspiration thrombectomy [7,12,31,35,[38][39][40][41][42][45][46][47]. However, none of these studies focus on the dependence of aspiration outcomes on clot-length, and do not include any modeling of the clot-artery interface, which is essential for understanding the limitations of the procedure.…”

Section: Discussionmentioning

confidence: 99%

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Computational Analysis of Effects of Clot Length on Acute Ischemic Stroke Recanalization under Different Cyclic Aspiration Loading Conditions

Patki

Simon

Manning

et al. 2022

Preprint

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Acute ischemic stroke, the second leading cause of death worldwide, results from occlusion of a cerebral artery by a blood clot. Application of cyclic aspiration using an aspiration catheter is a current therapy for the removal of lodged clots. In this study, we perform finite element simulations to analyze deformation of long clots, having length to radius ratio of 2 to 10, which corresponds to clot-length of 2.85–14.25 mm, under peak-to-peak cyclic aspiration pressures of 10 to 50 mmmHg, and frequencies of 0.5, 1 and 2 Hz. Our computational system comprises of a nonlinear viscoelastic solid clot, a hyperelastic artery, and a nonlinear viscoelastic cohesive zone, the latter modeling the clot–artery interface. We observe that clots having length-to-radius ratio approximately greater than two separate from the inner arterial surface somewhere between the axial and distal ends, irrespective of the cyclic aspiration loading conditions. The stress distribution within the clot shows large tensile stresses in the clot interior, indicating the possibility of simultaneous fragmentation of the clot. Thus, this study shows us the various failure mechanisms simultaneously present in the clot during cyclic aspiration. Similarly, the stress distribution within the artery implies a possibility of endothelial damage to the arterial wall near the end where the aspiration pressure is applied. This framework provides a foundation for further investigation to clot fracture and adhesion characterization.

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“…Also, three-dimensional computational fluid dynamics (CFD) simulations to compute the blood flow in a realistic CoW were performed and, in a study by Neidlin et al ,8 a numerical framework for aspiration thrombectomy using CFD was introduced. Other numerical studies focused on the mechanics of clot extraction by, for example, investigating the suction force/distance relationship or the evaluation of catheter geometry 9 10. Several hydrodynamic in vitro experiments have investigated the effect of aspiration pressure,11 perfusion pressure and collateral flow,12 and the comparison of different catheters and pumps 13–15…”

Section: Introductionmentioning

confidence: 99%

Flow control in the middle cerebral artery during thrombectomy: the effect of anatomy, catheter size and tip location

Neidlin

Yousefian

Luisi

et al. 2022

J NeuroIntervent Surg

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BackgroundCatheter size, location and circle of Willis anatomy impact the flow conditions during interventional stroke therapy. The aim of the study was to systematically investigate the influence of these factors on flow control in the middle cerebral artery by means of a computational model based on 100 patients with stroke who received endovascular treatment.MethodsThe dimensions of the cervical and intracranial cerebral arteries of 100 patients who received endovascular mechanical thrombectomy for acute ischemic stroke were measured and a three-dimensional model of the circle of Willis was created based on these data. Flow control in the middle cerebral artery with variations in catheter size, catheter location and configurations of collateral vessels was determined using a computational model. A total of 48 scenarios were analyzed.ResultsFlow reversal with a distal aspiration catheter alone was not possible in the internal carotid artery and only sometimes possible in the middle cerebral artery (14 of 48 cases). The Catalyst 7 catheter was more often successful in achieving flow reversal than Catalyst 5 or 6 catheters (p<0.001). In a full circle of Willis anatomy, flow reversal was almost never possible. The absence of one or more communicating arteries significantly influenced flow direction compared with the full anatomy with all communicating arteries present (p=0.028).ConclusionChoosing the biggest possible aspiration catheter and locating it in the middle cerebral artery significantly increases the chances of successful flow control. Flow through the collaterals may impair the flow, and circle of Willis anatomy should be considered during aspiration thrombectomy.

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Numerical modelling of blood clot extraction by aspiration thrombectomy. Evaluation of aspiration catheter geometry

Cited by 11 publications

References 12 publications

Applicability assessment of a stent-retriever thrombectomy finite-element model

Applicability assessment of a stent-retriever thrombectomy finite-element model

Computational Analysis of Effects of Clot Length on Acute Ischemic Stroke Recanalization under Different Cyclic Aspiration Loading Conditions

Flow control in the middle cerebral artery during thrombectomy: the effect of anatomy, catheter size and tip location

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