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

<b>Background</b>: 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 simulation...

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Auteurs principaux:	Emily Louise Manchester, Dylan Roi, Boram Gu, Xiao Yun Xu, Kyriakos Lobotesis
Format:	article
Langue:	EN
Publié:	MDPI AG 2021
Sujets:	stroke intravenous thrombolysis mechanical thrombectomy stent retriever numerical model computational fluid dynamics Science Q
Accès en ligne:	https://doaj.org/article/9e072e6a5f424050b3f6cf06a2d24a6c
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spelling	oai:doaj.org-article:9e072e6a5f424050b3f6cf06a2d24a6c2021-11-25T18:11:44ZModelling Combined Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischaemic Stroke: Understanding the Relationship between Stent Retriever Configuration and Clot Lysis Mechanisms10.3390/life111112712075-1729https://doaj.org/article/9e072e6a5f424050b3f6cf06a2d24a6c2021-11-01T00:00:00Zhttps://www.mdpi.com/2075-1729/11/11/1271https://doaj.org/toc/2075-1729<b>Background</b>: 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. <b>Methods</b>: 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. <b>Results</b>: 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. <b>Conclusions</b>: 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.Emily Louise ManchesterDylan RoiBoram GuXiao Yun XuKyriakos LobotesisMDPI AGarticlestrokeintravenous thrombolysismechanical thrombectomystent retrievernumerical modelcomputational fluid dynamicsScienceQENLife, Vol 11, Iss 1271, p 1271 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	stroke intravenous thrombolysis mechanical thrombectomy stent retriever numerical model computational fluid dynamics Science Q
spellingShingle	stroke intravenous thrombolysis mechanical thrombectomy stent retriever numerical model computational fluid dynamics Science Q Emily Louise Manchester Dylan Roi Boram Gu Xiao Yun Xu Kyriakos Lobotesis Modelling Combined Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischaemic Stroke: Understanding the Relationship between Stent Retriever Configuration and Clot Lysis Mechanisms
description	<b>Background</b>: 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. <b>Methods</b>: 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. <b>Results</b>: 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. <b>Conclusions</b>: 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.
format	article
author	Emily Louise Manchester Dylan Roi Boram Gu Xiao Yun Xu Kyriakos Lobotesis
author_facet	Emily Louise Manchester Dylan Roi Boram Gu Xiao Yun Xu Kyriakos Lobotesis
author_sort	Emily Louise Manchester
title	Modelling Combined Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischaemic Stroke: Understanding the Relationship between Stent Retriever Configuration and Clot Lysis Mechanisms
title_short	Modelling Combined Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischaemic Stroke: Understanding the Relationship between Stent Retriever Configuration and Clot Lysis Mechanisms
title_full	Modelling Combined Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischaemic Stroke: Understanding the Relationship between Stent Retriever Configuration and Clot Lysis Mechanisms
title_fullStr	Modelling Combined Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischaemic Stroke: Understanding the Relationship between Stent Retriever Configuration and Clot Lysis Mechanisms
title_full_unstemmed	Modelling Combined Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischaemic Stroke: Understanding the Relationship between Stent Retriever Configuration and Clot Lysis Mechanisms
title_sort	modelling combined intravenous thrombolysis and mechanical thrombectomy in acute ischaemic stroke: understanding the relationship between stent retriever configuration and clot lysis mechanisms
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/9e072e6a5f424050b3f6cf06a2d24a6c
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Modelling Combined Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischaemic Stroke: Understanding the Relationship between Stent Retriever Configuration and Clot Lysis Mechanisms

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