Combined stent-retriever and aspiration intra-arterial thrombectomy performance for fragmentable blood clots: A proof-of-concept computational study

Giulia Luraghi; Sara Bridio; Vittorio Lissoni; Gabriele Dubini; Anushree Dwivedi; Ray McCarthy; Behrooz Fereidoonnezhad; Patrick McGarry; Frank J H Gijsen; Jose Felix Rodriguez Matas; Francesco Migliavacca

doi:10.1016/j.jmbbm.2022.105462

Combined stent-retriever and aspiration intra-arterial thrombectomy performance for fragmentable blood clots: A proof-of-concept computational study

J Mech Behav Biomed Mater. 2022 Nov:135:105462. doi: 10.1016/j.jmbbm.2022.105462. Epub 2022 Sep 14.

Affiliations

¹ Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands. Electronic address: giulia.luraghi@polimi.it.
² Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.
³ Cerenovus, Neuro Technology Center, Galway, Ireland.
⁴ Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; Department of Biomedical Engineering, National University of Ireland Galway, Galway, Ireland.
⁵ Department of Biomedical Engineering, National University of Ireland Galway, Galway, Ireland.
⁶ Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands; Department of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.

PMID: 36116343
DOI: 10.1016/j.jmbbm.2022.105462

Abstract

Mechanical thrombectomy (MT) treatment of acute ischemic stroke (AIS) patients typically involves use of stent retrievers or aspiration catheters alone or in combination. For in silico trials of AIS patients, it is crucial to incorporate the possibility of thrombus fragmentation during the intervention. This study focuses on two aspects of the thrombectomy simulation: i) Thrombus fragmentation on the basis of a failure model calibrated with experimental tests on clot analogs; ii) the combined stent-retriever and aspiration catheter MT procedure is modeled by adding both the proximal balloon guide catheter and the distal access catheter. The adopted failure criterion is based on maximum principal stress threshold value. If elements of the thrombus exceed this criterion during the retrieval simulation, then they are deleted from the calculation. Comparison with in-vitro tests indicates that the simulation correctly reproduces the procedures predicting thrombus fragmentation in the case of red blood cells rich thrombi, whereas non-fragmentation is predicted for fibrin-rich thrombi. Modeling of balloon guide catheter prevents clot fragments' embolization to further distal territories during MT procedure.

Keywords: Acute ischemic stroke; Finite element analysis; Stent-retriever; Thrombectomy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Fibrin
Humans
Ischemic Stroke*
Stents
Thrombectomy / adverse effects
Thrombectomy / methods
Thrombosis* / therapy
Treatment Outcome

Substances

Fibrin