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Modelling the impact of clot fragmentation on the microcirculation after thrombectomy
Many ischaemic stroke patients who have a mechanical removal of their clot (thrombectomy) do not get reperfusion of tissue despite the thrombus being removed. One hypothesis for this ‘no-reperfusion’ phenomenon is micro-emboli fragmenting off the large clot during thrombectomy and occluding smaller...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7990195/ https://www.ncbi.nlm.nih.gov/pubmed/33711015 http://dx.doi.org/10.1371/journal.pcbi.1008515 |
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author | El-Bouri, Wahbi K. MacGowan, Andrew Józsa, Tamás I. Gounis, Matthew J. Payne, Stephen J. |
author_facet | El-Bouri, Wahbi K. MacGowan, Andrew Józsa, Tamás I. Gounis, Matthew J. Payne, Stephen J. |
author_sort | El-Bouri, Wahbi K. |
collection | PubMed |
description | Many ischaemic stroke patients who have a mechanical removal of their clot (thrombectomy) do not get reperfusion of tissue despite the thrombus being removed. One hypothesis for this ‘no-reperfusion’ phenomenon is micro-emboli fragmenting off the large clot during thrombectomy and occluding smaller blood vessels downstream of the clot location. This is impossible to observe in-vivo and so we here develop an in-silico model based on in-vitro experiments to model the effect of micro-emboli on brain tissue. Through in-vitro experiments we obtain, under a variety of clot consistencies and thrombectomy techniques, micro-emboli distributions post-thrombectomy. Blood flow through the microcirculation is modelled for statistically accurate voxels of brain microvasculature including penetrating arterioles and capillary beds. A novel micro-emboli algorithm, informed by the experimental data, is used to simulate the impact of micro-emboli successively entering the penetrating arterioles and the capillary bed. Scaled-up blood flow parameters–permeability and coupling coefficients–are calculated under various conditions. We find that capillary beds are more susceptible to occlusions than the penetrating arterioles with a 4x greater drop in permeability per volume of vessel occluded. Individual microvascular geometries determine robustness to micro-emboli. Hard clot fragmentation leads to larger micro-emboli and larger drops in blood flow for a given number of micro-emboli. Thrombectomy technique has a large impact on clot fragmentation and hence occlusions in the microvasculature. As such, in-silico modelling of mechanical thrombectomy predicts that clot specific factors, interventional technique, and microvascular geometry strongly influence reperfusion of the brain. Micro-emboli are likely contributory to the phenomenon of no-reperfusion following successful removal of a major clot. |
format | Online Article Text |
id | pubmed-7990195 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-79901952021-04-05 Modelling the impact of clot fragmentation on the microcirculation after thrombectomy El-Bouri, Wahbi K. MacGowan, Andrew Józsa, Tamás I. Gounis, Matthew J. Payne, Stephen J. PLoS Comput Biol Research Article Many ischaemic stroke patients who have a mechanical removal of their clot (thrombectomy) do not get reperfusion of tissue despite the thrombus being removed. One hypothesis for this ‘no-reperfusion’ phenomenon is micro-emboli fragmenting off the large clot during thrombectomy and occluding smaller blood vessels downstream of the clot location. This is impossible to observe in-vivo and so we here develop an in-silico model based on in-vitro experiments to model the effect of micro-emboli on brain tissue. Through in-vitro experiments we obtain, under a variety of clot consistencies and thrombectomy techniques, micro-emboli distributions post-thrombectomy. Blood flow through the microcirculation is modelled for statistically accurate voxels of brain microvasculature including penetrating arterioles and capillary beds. A novel micro-emboli algorithm, informed by the experimental data, is used to simulate the impact of micro-emboli successively entering the penetrating arterioles and the capillary bed. Scaled-up blood flow parameters–permeability and coupling coefficients–are calculated under various conditions. We find that capillary beds are more susceptible to occlusions than the penetrating arterioles with a 4x greater drop in permeability per volume of vessel occluded. Individual microvascular geometries determine robustness to micro-emboli. Hard clot fragmentation leads to larger micro-emboli and larger drops in blood flow for a given number of micro-emboli. Thrombectomy technique has a large impact on clot fragmentation and hence occlusions in the microvasculature. As such, in-silico modelling of mechanical thrombectomy predicts that clot specific factors, interventional technique, and microvascular geometry strongly influence reperfusion of the brain. Micro-emboli are likely contributory to the phenomenon of no-reperfusion following successful removal of a major clot. Public Library of Science 2021-03-12 /pmc/articles/PMC7990195/ /pubmed/33711015 http://dx.doi.org/10.1371/journal.pcbi.1008515 Text en © 2021 El-Bouri et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article El-Bouri, Wahbi K. MacGowan, Andrew Józsa, Tamás I. Gounis, Matthew J. Payne, Stephen J. Modelling the impact of clot fragmentation on the microcirculation after thrombectomy |
title | Modelling the impact of clot fragmentation on the microcirculation after thrombectomy |
title_full | Modelling the impact of clot fragmentation on the microcirculation after thrombectomy |
title_fullStr | Modelling the impact of clot fragmentation on the microcirculation after thrombectomy |
title_full_unstemmed | Modelling the impact of clot fragmentation on the microcirculation after thrombectomy |
title_short | Modelling the impact of clot fragmentation on the microcirculation after thrombectomy |
title_sort | modelling the impact of clot fragmentation on the microcirculation after thrombectomy |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7990195/ https://www.ncbi.nlm.nih.gov/pubmed/33711015 http://dx.doi.org/10.1371/journal.pcbi.1008515 |
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