Impact of the Internal Carotid Artery Morphology on in silico Stent-Retriever Thrombectomy Outcome

Frontiers in Medical Technology

卷:3

Ed van Bavel¹  Nerea Arrarte Terreros²  Charles B. L. M. Majoie²  Praneeta R. Konduri²  Henk A. Marquering²  Jose F. Rodriguez Matas³  Gabriele Dubini³  Giorgia G. Giassi³  Francesco Migliavacca³  Greta Maggio³  Julia N. Kawamoto³  Giulia Luraghi³  Sara Bridio³  Patrick McGarry⁴  Kevin M. Moerman⁴ 

[1] Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, Netherlands;

[2] Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, Netherlands;

[3] Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering, Politecnico di Milano, Milan, Italy;

[4] School of Engineering, National University of Ireland Galway, Galway, Ireland;

关键词: insist;    finite element analysis;    carotid siphon;    acute ischemic stroke;    internal carotid artery;    digital twin;   

DOI  :  10.3389/fmedt.2021.719909

来源: DOAJ

【 摘 要 】

The aim of this work is to propose a methodology for identifying relationships between morphological features of the cerebral vasculature and the outcome of in silico simulations of thrombectomy, the mechanical treatment for acute ischemic stroke. Fourteen patient-specific cerebral vasculature segmentations were collected and used for geometric characterization of the intracranial arteries mostly affected by large vessel occlusions, i.e., internal carotid artery (ICA), middle cerebral artery (MCA) and anterior cerebral artery (ACA). First, a set of global parameters was created, including the geometrical information commonly provided in the clinical context, namely the total length, the average diameter and the tortuosity (length over head-tail distance) of the intracranial ICA. Then, a more exhaustive geometrical analysis was performed to collect a set of local parameters. A total of 27 parameters was measured from each patient-specific vascular configuration. Fourteen virtual thrombectomy simulations were performed with a blood clot with the same length and composition placed in the middle of the MCA. The model of TREVO ProVue stent-retriever was used for all the simulations. Results from simulations produced five unsuccessful outcomes, i.e., the clot was not removed from the vessels. The geometric parameters of the successful and unsuccessful simulations were compared to find relations between the vascular geometry and the outcome. None of the global parameters alone or combined proved able to discriminate between positive and negative outcome, while a combination of local parameters allowed to correctly identify the successful from the unsuccessful simulations. Although these results are limited by the number of patients considered, this study indicates a promising methodology to relate patient-specific geometry to virtual thrombectomy outcome, which might eventually guide decision making in the treatment of acute ischemic stroke.

【 授权许可】

Unknown