Suction force-suction distance relation during aspiration thrombectomy for ischemic stroke: A computational fluid dynamics study

Shi, Yubing; Cheshire, David; Lally, Frank; Roffe, Christine

doi:10.1016/j.phmed.2016.11.001

Cited by 33 publications

(29 citation statements)

References 26 publications

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“…When the aspiration pump is turned on, there should be a further decrease in impaction force, with one in-vitro study reporting flow reversal [ 31 ]. The suction force on the thrombus be comes appreciable when the catheter tip is close to the thrombus (<1 mm) and increases until the catheter comes into contact with the thrombus [ 32 ]. One concern is that once the thrombus is engaged, the suction forces within the vessel lumen are lost, and flow around the intermediate catheter may result in fragmentation and distal embolization during retrieval, which has been reported in an in-vitro model [ 31 ].…”

Section: Challenges To Procedural Successmentioning

confidence: 99%

Thrombectomy in Acute Ischemic Stroke: Challenges to Procedural Success

Yoo¹,

2017

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The overwhelming clinical benefit of intra-arterial stroke therapy owes to the major advance in revascularization brought on by the current generation of thrombectomy devices. Nevertheless, there remains a sizeable proportion of patients for whom substantial reperfusion cannot be achieved or is achieved too late. This article addresses the persistent challenges that face neurointerventionists and reviews technical refinements that may help to mitigate these obstacles to procedural success. Insights from in vitro modeling and clinical research are organized around a conceptual framework that examines the interaction between the device, the thrombus and the vessel wall.

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Section: Challenges To Procedural Successmentioning

confidence: 99%

Thrombectomy in Acute Ischemic Stroke: Challenges to Procedural Success

Yoo¹,

2017

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“…Some researchers focused on the flow pattern around the commercial aspiration devices without considering the effect of thrombus deformation during aspiration. Computational fluid dynamics were implemented to investigate the relations between suction pressure and applied force to thrombus in fully occluded middle cerebral arteries condition during aspiration by Shi et al . Two‐phase flow was adapted to model the clot as a viscous fluid immersed in fluid phase of blood.…”

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confidence: 99%

Three‐Dimensional Numerical Simulations of Aspiration Process: Evaluation of Two Penumbra Aspiration Catheters Performance

2018

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Acute ischemic stroke (AIS) is the leading cause of mortality and disability worldwide. AIS occur while cerebral arteries become blocked by embolism or thrombosis. Aspiration thrombectomy is a promising interventional device to extract massive clots from occluded cerebral arteries. The aim of this article is to develop a computer-aided method to clarify the performance of aspiration catheter and identify the risks of aspiration for each specific AIS patient. In order to simulate the aspiration process, a three-dimensional fluid-structure interaction (FSI) method was developed. The blood clot was modeled as a porous media which composed of viscoelastic fibrin networks. The finite element method (FEM) was implemented to compute the blood flow dynamics in the simplified cerebral vessel. The introduced clot model was validated by comparing the numerical results with experimental data. Furthermore, the analytical solution of the flow through the partially porous pipe was considered to validate FEM. In this research, the performance of two model of the Penumbra aspiration catheter-4MAX and 5MAX-were were compared at three distinct suction pressures. The aspiration ratio of the clot, aspiration time, amount of free fragments, wall shear stress (WSS), and extracted volume of the blood were calculated to evaluate catheters performance. At suction pressure −50 kPa, the aspiration ratio of 5MAX catheter reached 86.58% within 1.36 s. However, in 4MAX case, aspiration ratio of 76.41% was achieved within 1.39. Also, 5MAX catheter created 6.11% fewer free fragments in comparison to 4MAX. Hence, the possibility of distal embolization of 4MAX model was greater. However, the risk of vessel wall rupture was higher in 5MAX by considering mean WSS.

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“…The physics underlying aspiration thrombectomy are highly complex and influenced by multiple variables including the distorted flow profile due to the irregular geometry of the brain vessels, the nonlinear contact and frictional forces between the thrombus and the vessel wall, and the suction action produced by the aspiration procedure. 10 Notwithstanding, from a pragmatic standpoint, there are three main physical properties that seem to impact the likelihood of a successful aspiration: 1) suction force, 2) aspiration flow and 3) flow control; all of which are optimized by a larger catheter diameter. The laminar flow rate of an incompressible fluid along a cylindrical pipe is governed by Hagen-Poiseuille's law, which states that flow is a function of radius to the fourth power, pressure, viscosity, and length.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is becoming progressively more clear that catheter aspiration flow has little impact on the initial clot retrieval particularly in the setting of a full occlusion as the aspirate is primarily drawn from the vessels proximal to the occlusion. 10,11 Moreover, flow near completely or entirely ceases once the catheter tip is occluded by the thrombus. 12 Once antegrade flow is reestablished, aspiration flow probably plays an important role by minimizing distal embolization.…”

Section: Discussionmentioning

confidence: 99%

“…12 Once antegrade flow is reestablished, aspiration flow probably plays an important role by minimizing distal embolization. Thus, suction force, which is defined by the summation of all the pressure forces acting on the proximal and the distal surfaces of the thrombus, 10 is likely the most important driver of aspiration success. As the retrieving force exerted on the clot by the catheter is a direct function of the vacuum pressure and the cross-sectional area of the catheter tip (i.e.…”

Section: Discussionmentioning

confidence: 99%

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Preliminary experience with 088 large bore intracranial catheters during stroke thrombectomy

et al. 2020

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Background and purpose Thromboaspiration technology continues to evolve at an accelerated pace with increasing availability of larger and more navigable devices. Herein, we provide our initial experience with the intracranial navigation of a large-bore (.088" inner diameter) catheters during mechanical thrombectomy (MT). Methods Retrospective review of consecutive large vessel occlusion stroke patients in whom a TracStar™ or Zoom 88™ (Imperative Care, Campbell, CA) large-bore catheters were utilized in MT. The primary outcome was successful reperfusion (eTICI2b-3) at the end of the procedure. Safety measures included procedural complications and rates of symptomatic intracranial hemorrhage. Results Five patients (age,∼50–85 years; baseline NIHSS,17-23) were treated. The .088" catheters were used as the primary tool for contact aspiration in two patients (distal basilar artery and proximal MCA occlusions) with complete thrombus ingestion (eTICI3) during the first pass. In two patients, the .088" catheter was used for flow control where it was placed in the distal M1-segment of a patient with M2 occlusion treated with a combination of stent-retriever and .070" aspiration catheter and in the proximal M1 in a patient with distal M1 occlusion treated with .071" aspiration catheter resulting in eTICI3 reperfusion in both cases. In the fifth patient, the .088" catheter was navigated into the cavernous ICA to support .071" aspiration catheter treatment of an M2 occlusion resulting in eTCI2b67 reperfusion. Procedural duration ranged between 14 and 33 minutes. There were no adverse events. Conclusion Intracranial navigation of .088" large-bore catheters in MT appears technically feasible and safe. Larger prospective studies are warranted.

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Suction force-suction distance relation during aspiration thrombectomy for ischemic stroke: A computational fluid dynamics study

Cited by 33 publications

References 26 publications

Thrombectomy in Acute Ischemic Stroke: Challenges to Procedural Success

Thrombectomy in Acute Ischemic Stroke: Challenges to Procedural Success

Three‐Dimensional Numerical Simulations of Aspiration Process: Evaluation of Two Penumbra Aspiration Catheters Performance

Preliminary experience with 088 large bore intracranial catheters during stroke thrombectomy

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