In vitro and in silico modeling of endovascular stroke treatments for acute ischemic stroke

Luraghi, Giulia; Cahalane, Rachel M.; Ven, Emma van de; Overschie, Serena C.M.; Gijsen, Frank; Akyildiz, Ali C.

doi:10.1016/j.jbiomech.2021.110693

Cited by 22 publications

(17 citation statements)

References 65 publications

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“…In addition to physical models, computational modeling is gaining attention and likely to have an increasing role in medical device development ( 57 , 90 – 92 ). Finite element modeling is recommended by the FDA, in the guidance for non-clinical testing of stents and associated delivery systems, as a means of performing stress and fatigue analysis on the devices seeking approval ( 93 ).…”

Section: Discussion and Recommendations For Future Advancementsmentioning

confidence: 99%

A Review of the Advancements in the in-vitro Modelling of Acute Ischemic Stroke and Its Treatment

Johnson

Dwivedi

Mirza

et al. 2022

Front. Med. Technol.

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In-vitro neurovascular models of large vessel occlusions (LVOs) causing acute ischemic stroke (AIS) are used extensively for pre-clinical testing of new treatment devices. They enable physicians and engineers to examine device performance and the response of the occlusion to further advance design solutions for current unmet clinical needs. These models also enable physicians to train on basic skills, to try out new devices and new procedural approaches, and for the stroke team to practice workflows together in the comfort of a controlled environment in a non-clinical setting. Removal of the occlusive clot in its entirety is the primary goal of the endovascular treatment of LVOs via mechanical thrombectomy (MT) and the medical treatment via thrombolysis. In MT, recanalization after just one pass is associated with better clinical outcomes than procedures that take multiple passes to achieve the same level of recanalization, commonly known as first pass effect (FPE). To achieve this, physicians and engineers are continually investigating new devices and treatment approaches. To distinguish between treatment devices in the pre-clinical setting, test models must also be optimized and expanded become more nuanced and to represent challenging patient cohorts that could be improved through new technology or better techniques. The aim of this paper is to provide a perspective review of the recent advancements in the in-vitro modeling of stroke and to outline how these models need to advance further in future. This review provides an overview of the various in-vitro models used for the modeling of AIS and compares the advantages and limitations of each. In-vitro models remain an extremely useful tool in the evaluation and design of treatment devices, and great strides have been made to improve replication of physiological conditions. However, further advancement is still required to represent the expanding indications for thrombectomy and thrombolysis, and the generation of new thrombectomy devices, to ensure that smaller treatment effects are captured.

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Section: Discussion and Recommendations For Future Advancementsmentioning

confidence: 99%

A Review of the Advancements in the in-vitro Modelling of Acute Ischemic Stroke and Its Treatment

Johnson

Dwivedi

Mirza

et al. 2022

Front. Med. Technol.

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“…To date, several studies have analyzed in vitro stent retrieval ( 23 – 25 ). However, the artificial vascular models used in these studies were designed to have only simple curvatures that were not similar to real cerebral vascular structures.…”

Section: Discussionmentioning

confidence: 99%

Frictional force analysis of stent retriever devices using a realistic vascular model: Pilot study

et al. 2022

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ObjectiveTo date, no vascular model to analyze frictional forces between stent retriever devices and vessel walls has been designed to be similar to the real human vasculature. We developed a novel in vitro intracranial cerebrovascular model and analyzed frictional forces of three stent retriever devices.MethodsA vascular mold was created based on digital subtraction angiography of a patient's cerebral vessels. The vascular model was constructed using polydimethylsiloxane (PDMS, Dow Corning, Inc.) as a silicone elastomer. The vascular model was coated on its inner surface with a lubricating layer to create a low coefficient of friction (~0.037) to closely approximate the intima. A pulsatile blood pump was used to produce blood flow inside the model to approximate real vascular conditions. The frictional forces of Trevo XP, Solitaire 2, and Eric 4 were analyzed for initial and maximal friction retrieval forces using this vascular model. The total pulling energy generated during the 3 cm movement was also obtained.ResultsResults for initial retrieval force were as follows: Trevo, 0.09 ± 0.04 N; Solitaire, 0.25 ± 0.07 N; and Eric, 0.33 ± 0.21 N. Results for maximal retrieval force were as follows: Trevo, 0.36 ± 0.07 N; Solitaire, 0.54 ± 0.06 N; and Eric, 0.80 ± 0.13 N. Total pulling energy (N·cm) was 0.40 ± 0.10 in Trevo, 0.65 ± 0.10 in Solitaire, and 0.87 ± 0.14 in Eric, respectively.ConclusionsUsing a realistic vascular model, different stent retriever devices were shown to have statistically different frictional forces. Future studies using a realistic vascular model are warranted to assess SRT devices.

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“…There is a significant lack of data on the mechanical properties of arterial tissues, especially for the separate layers of vessel walls, due to several practical reasons [37]. Moreover, the data on cerebral arteries is even limited, due to a lack of pragmatic mechanical catheterization [26]. In this context, several previous numerical studies on aspiration have modeled the arterial wall as rigid [7, 14, 35, 42].…”

Section: Discussionmentioning

confidence: 99%

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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In vitro and in silico modeling of endovascular stroke treatments for acute ischemic stroke

Cited by 22 publications

References 65 publications

A Review of the Advancements in the in-vitro Modelling of Acute Ischemic Stroke and Its Treatment

A Review of the Advancements in the in-vitro Modelling of Acute Ischemic Stroke and Its Treatment

Frictional force analysis of stent retriever devices using a realistic vascular model: Pilot study

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

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