@article{Manchester:2021:10.3390/life11111271,
author = {Manchester, E and Roi, D and Gu, B and Xu, X and Lobotesis, K},
doi = {10.3390/life11111271},
journal = {Life},
title = {Modelling combined intravenous thrombolysis and mechanical thrombectomy in acute ischaemic stroke: Understanding the relationship between stent retriever configuration and clot lysis mechanisms},
url = {http://dx.doi.org/10.3390/life11111271},
volume = {11},
year = {2021}
}

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TY  - JOUR
AB  - 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.
AU  - Manchester,E
AU  - Roi,D
AU  - Gu,B
AU  - Xu,X
AU  - Lobotesis,K
DO  - 10.3390/life11111271
PY  - 2021///
SN  - 2075-1729
TI  - Modelling combined intravenous thrombolysis and mechanical thrombectomy in acute ischaemic stroke: Understanding the relationship between stent retriever configuration and clot lysis mechanisms
T2  - Life
UR  - http://dx.doi.org/10.3390/life11111271
UR  - http://hdl.handle.net/10044/1/93058
VL  - 11
ER  - 

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