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Inadvertent Detachment of Stent Retrievers during Mechanical Thrombectomy—A Clinical and Biomechanical Perspective
 
 
Article

Modelling Combined Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischaemic Stroke: Understanding the Relationship between Stent Retriever Configuration and Clot Lysis Mechanisms

1
Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
2
Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 8RF, UK
3
School of Chemical Engineering, Chonnam National University, Gwangju 61186, Korea
*
Authors to whom correspondence should be addressed.
Academic Editors: Gergely Fehér, Péter Klivényi and Joel Rodriguez-Saldana
Life 2021, 11(11), 1271; https://doi.org/10.3390/life11111271
Received: 25 October 2021 / Revised: 10 November 2021 / Accepted: 18 November 2021 / Published: 20 November 2021
(This article belongs to the Special Issue Challenges in Stroke Care)
Background: Combined intravenous thrombolysis and mechanical thrombectomy (IVT-MT) is a common treatment in acute ischaemic stroke, however the interaction between IVT and MT from a physiological standpoint is poorly understood. In this pilot study, we conduct numerical simulations of combined IVT-MT with various idealised stent retriever configurations to evaluate performance in terms of complete recanalisation times and lysis patterns. Methods: A 3D patient-specific geometry of a terminal internal carotid artery with anterior and middle cerebral arteries is reconstructed, and a thrombus is artificially implanted in the MCA branch. Various idealised stent retriever configurations are implemented by varying stent diameter and stent placement, and a configuration without a stent retriever provides a baseline for comparison. A previously validated multi-level model of thrombolysis is used, which incorporates blood flow, drug transport, and fibrinolytic reactions within a fibrin thrombus. Results: Fastest total recanalisation was achieved in the thrombus without a stent retriever, with lysis times increasing with stent retriever diameter. Two mechanisms of clot lysis were established: axial and radial permeation. Axial permeation from the clot front was the primary mechanism of lysis in all configurations, as it facilitated increased protein binding with fibrin fibres. Introducing a stent retriever channel allowed for radial permeation, which occurred at the fluid-thrombus interface, although lysis was much slower in the radial direction because of weaker secondary velocities. Conclusions: Numerical models can be used to better understand the complex physiological relationship between IVT and MT. Two different mechanisms of lysis were established, providing a basis towards improving the efficacy of combined treatments. View Full-Text
Keywords: stroke; intravenous thrombolysis; mechanical thrombectomy; stent retriever; numerical model; computational fluid dynamics; blood flow; carotid artery; cerebral artery stroke; intravenous thrombolysis; mechanical thrombectomy; stent retriever; numerical model; computational fluid dynamics; blood flow; carotid artery; cerebral artery
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MDPI and ACS Style

Manchester, E.L.; Roi, D.; Gu, B.; Xu, X.Y.; Lobotesis, K. Modelling Combined Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischaemic Stroke: Understanding the Relationship between Stent Retriever Configuration and Clot Lysis Mechanisms. Life 2021, 11, 1271. https://doi.org/10.3390/life11111271

AMA Style

Manchester EL, Roi D, Gu B, Xu XY, Lobotesis K. Modelling Combined Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischaemic Stroke: Understanding the Relationship between Stent Retriever Configuration and Clot Lysis Mechanisms. Life. 2021; 11(11):1271. https://doi.org/10.3390/life11111271

Chicago/Turabian Style

Manchester, Emily Louise, Dylan Roi, Boram Gu, Xiao Yun Xu, and Kyriakos Lobotesis. 2021. "Modelling Combined Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischaemic Stroke: Understanding the Relationship between Stent Retriever Configuration and Clot Lysis Mechanisms" Life 11, no. 11: 1271. https://doi.org/10.3390/life11111271

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