Microcatheter tracking in thrombectomy procedures: A finite-element simulation study

N.A. Terreros; S. Renon; F. Zucchelli; S. Bridio; J.F.R. Matas; G. Dubini; P.R. Konduri; M.S. Koopman; W.H.V. Zwam; L.S.F. Yo; R.H. Lo; H.A. Marquering; E. van Bavel; C.B.L.M. Majoie; F. Migliavacca; G. Luraghi

doi:10.1016/j.cmpb.2023.107515

Microcatheter tracking in thrombectomy procedures: A finite-element simulation study

N.A. Terreros, S. Renon, F. Zucchelli, S. Bridio, J.F.R. Matas, G. Dubini, P.R. Konduri, M.S. Koopman, W.H.V. Zwam, L.S.F. Yo, R.H. Lo, H.A. Marquering, E. van Bavel, C.B.L.M. Majoie, F. Migliavacca, G. Luraghi^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background and objective: Mechanical thrombectomy is a minimally invasive procedure that aims at re-moving the occluding thrombus from the vasculature of acute ischemic stroke patients. Thrombectomy success and failure can be studied using in-silico thrombectomy models. Such models require realistic modeling steps to be effective. We here present a new approach to model microcatheter tracking during thrombectomy.Methods: For 3 patient-specific vessel geometries, we performed finite-element simulations of the micro-catheter tracking (1) following the vessel centerline (centerline method) and (2) as a one-step insertion simulation, where the microcatheter tip was advanced along the vessel centerline while its body was free to interact with the vessel wall (tip-dragging method). Qualitative validation of the two tracking methods was performed with the patient's digital subtraction angiography (DSA) images. In addition, we com-pared simulated thrombectomy outcomes (successful vs unsuccessful thrombus retrieval) and maximum principal stresses on the thrombus between the centerline and tip-dragging method.Results: Qualitative comparison with the DSA images showed that the tip-dragging method more realisti-cally resembles the patient-specific microcatheter-tracking scenario, where the microcatheter approaches the vessel walls. Although the simulated thrombectomy outcomes were similar in terms of thrombus retrieval, the thrombus stress fields (and the associated fragmentation of the thrombus) were strongly different between the two methods, with local differences in the maximum principal stress curves up to 84%.Conclusions: Microcatheter positioning with respect to the vessel affects the stress fields of the thrombus during retrieval, and therefore, may influence thrombus fragmentation and retrieval in-silico thrombec-tomy.(c) 2023 Elsevier B.V. All rights reserved.

Original language	English
Article number	107515
Number of pages	10
Journal	Computer Methods and Programs in Biomedicine
Volume	234
Issue number	1
DOIs	https://doi.org/10.1016/j.cmpb.2023.107515
Publication status	Published - 1 Jun 2023

Keywords

Thrombectomy
Acute ischemic stroke
Stent-retriever
Finite element analysis
MECHANICAL THROMBECTOMY
PREDICTION
GUIDEWIRE
CLOT

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Terreros, N. A., Renon, S., Zucchelli, F., Bridio, S., Matas, J. F. R., Dubini, G., Konduri, P. R., Koopman, M. S., Zwam, W. H. V., Yo, L. S. F., Lo, R. H., Marquering, H. A., van Bavel, E., Majoie, C. B. L. M., Migliavacca, F., & Luraghi, G. (2023). Microcatheter tracking in thrombectomy procedures: A finite-element simulation study. Computer Methods and Programs in Biomedicine, 234(1), Article 107515. https://doi.org/10.1016/j.cmpb.2023.107515

@article{9a9fc8747747404e81964c629daf3010,

title = "Microcatheter tracking in thrombectomy procedures: A finite-element simulation study",

abstract = "Background and objective: Mechanical thrombectomy is a minimally invasive procedure that aims at re-moving the occluding thrombus from the vasculature of acute ischemic stroke patients. Thrombectomy success and failure can be studied using in-silico thrombectomy models. Such models require realistic modeling steps to be effective. We here present a new approach to model microcatheter tracking during thrombectomy.Methods: For 3 patient-specific vessel geometries, we performed finite-element simulations of the micro-catheter tracking (1) following the vessel centerline (centerline method) and (2) as a one-step insertion simulation, where the microcatheter tip was advanced along the vessel centerline while its body was free to interact with the vessel wall (tip-dragging method). Qualitative validation of the two tracking methods was performed with the patient's digital subtraction angiography (DSA) images. In addition, we com-pared simulated thrombectomy outcomes (successful vs unsuccessful thrombus retrieval) and maximum principal stresses on the thrombus between the centerline and tip-dragging method.Results: Qualitative comparison with the DSA images showed that the tip-dragging method more realisti-cally resembles the patient-specific microcatheter-tracking scenario, where the microcatheter approaches the vessel walls. Although the simulated thrombectomy outcomes were similar in terms of thrombus retrieval, the thrombus stress fields (and the associated fragmentation of the thrombus) were strongly different between the two methods, with local differences in the maximum principal stress curves up to 84%.Conclusions: Microcatheter positioning with respect to the vessel affects the stress fields of the thrombus during retrieval, and therefore, may influence thrombus fragmentation and retrieval in-silico thrombec-tomy.(c) 2023 Elsevier B.V. All rights reserved.",

keywords = "Thrombectomy, Acute ischemic stroke, Stent-retriever, Finite element analysis, MECHANICAL THROMBECTOMY, PREDICTION, GUIDEWIRE, CLOT",

author = "N.A. Terreros and S. Renon and F. Zucchelli and S. Bridio and J.F.R. Matas and G. Dubini and P.R. Konduri and M.S. Koopman and W.H.V. Zwam and L.S.F. Yo and R.H. Lo and H.A. Marquering and {van Bavel}, E. and C.B.L.M. Majoie and F. Migliavacca and G. Luraghi",

note = "Funding Information: This project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 777072, the AMC medical Research BV, Amsterdam UMC, location University of Amsterdam, under project No 21937, the Dr. Catherine van Tussenbroek Fund under grant No A-2022-28, the Genootschap ter bevordering van Natuur-, Genees- en Heelkunde, and from the MIUR FISR-FISR2019_03221 CECOMES. The MR CLEAN Registry was partly funded by TWIN Foundation, Erasmus MC University Medical Center, Maastricht University Medical Center, and Amsterdam University Medical Centers. Publisher Copyright: {\textcopyright} 2023 Elsevier B.V.",

year = "2023",

month = jun,

day = "1",

doi = "10.1016/j.cmpb.2023.107515",

language = "English",

volume = "234",

journal = "Computer Methods and Programs in Biomedicine",

issn = "0169-2607",

publisher = "Elsevier Ireland Ltd",

number = "1",

}

Terreros, NA, Renon, S, Zucchelli, F, Bridio, S, Matas, JFR, Dubini, G, Konduri, PR, Koopman, MS, Zwam, WHV, Yo, LSF, Lo, RH, Marquering, HA, van Bavel, E, Majoie, CBLM, Migliavacca, F & Luraghi, G 2023, 'Microcatheter tracking in thrombectomy procedures: A finite-element simulation study', Computer Methods and Programs in Biomedicine, vol. 234, no. 1, 107515. https://doi.org/10.1016/j.cmpb.2023.107515

TY - JOUR

T1 - Microcatheter tracking in thrombectomy procedures: A finite-element simulation study

AU - Terreros, N.A.

AU - Renon, S.

AU - Zucchelli, F.

AU - Bridio, S.

AU - Matas, J.F.R.

AU - Dubini, G.

AU - Konduri, P.R.

AU - Koopman, M.S.

AU - Zwam, W.H.V.

AU - Yo, L.S.F.

AU - Lo, R.H.

AU - Marquering, H.A.

AU - van Bavel, E.

AU - Majoie, C.B.L.M.

AU - Migliavacca, F.

AU - Luraghi, G.

N1 - Funding Information: This project has received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 777072, the AMC medical Research BV, Amsterdam UMC, location University of Amsterdam, under project No 21937, the Dr. Catherine van Tussenbroek Fund under grant No A-2022-28, the Genootschap ter bevordering van Natuur-, Genees- en Heelkunde, and from the MIUR FISR-FISR2019_03221 CECOMES. The MR CLEAN Registry was partly funded by TWIN Foundation, Erasmus MC University Medical Center, Maastricht University Medical Center, and Amsterdam University Medical Centers. Publisher Copyright: © 2023 Elsevier B.V.

PY - 2023/6/1

Y1 - 2023/6/1

N2 - Background and objective: Mechanical thrombectomy is a minimally invasive procedure that aims at re-moving the occluding thrombus from the vasculature of acute ischemic stroke patients. Thrombectomy success and failure can be studied using in-silico thrombectomy models. Such models require realistic modeling steps to be effective. We here present a new approach to model microcatheter tracking during thrombectomy.Methods: For 3 patient-specific vessel geometries, we performed finite-element simulations of the micro-catheter tracking (1) following the vessel centerline (centerline method) and (2) as a one-step insertion simulation, where the microcatheter tip was advanced along the vessel centerline while its body was free to interact with the vessel wall (tip-dragging method). Qualitative validation of the two tracking methods was performed with the patient's digital subtraction angiography (DSA) images. In addition, we com-pared simulated thrombectomy outcomes (successful vs unsuccessful thrombus retrieval) and maximum principal stresses on the thrombus between the centerline and tip-dragging method.Results: Qualitative comparison with the DSA images showed that the tip-dragging method more realisti-cally resembles the patient-specific microcatheter-tracking scenario, where the microcatheter approaches the vessel walls. Although the simulated thrombectomy outcomes were similar in terms of thrombus retrieval, the thrombus stress fields (and the associated fragmentation of the thrombus) were strongly different between the two methods, with local differences in the maximum principal stress curves up to 84%.Conclusions: Microcatheter positioning with respect to the vessel affects the stress fields of the thrombus during retrieval, and therefore, may influence thrombus fragmentation and retrieval in-silico thrombec-tomy.(c) 2023 Elsevier B.V. All rights reserved.

AB - Background and objective: Mechanical thrombectomy is a minimally invasive procedure that aims at re-moving the occluding thrombus from the vasculature of acute ischemic stroke patients. Thrombectomy success and failure can be studied using in-silico thrombectomy models. Such models require realistic modeling steps to be effective. We here present a new approach to model microcatheter tracking during thrombectomy.Methods: For 3 patient-specific vessel geometries, we performed finite-element simulations of the micro-catheter tracking (1) following the vessel centerline (centerline method) and (2) as a one-step insertion simulation, where the microcatheter tip was advanced along the vessel centerline while its body was free to interact with the vessel wall (tip-dragging method). Qualitative validation of the two tracking methods was performed with the patient's digital subtraction angiography (DSA) images. In addition, we com-pared simulated thrombectomy outcomes (successful vs unsuccessful thrombus retrieval) and maximum principal stresses on the thrombus between the centerline and tip-dragging method.Results: Qualitative comparison with the DSA images showed that the tip-dragging method more realisti-cally resembles the patient-specific microcatheter-tracking scenario, where the microcatheter approaches the vessel walls. Although the simulated thrombectomy outcomes were similar in terms of thrombus retrieval, the thrombus stress fields (and the associated fragmentation of the thrombus) were strongly different between the two methods, with local differences in the maximum principal stress curves up to 84%.Conclusions: Microcatheter positioning with respect to the vessel affects the stress fields of the thrombus during retrieval, and therefore, may influence thrombus fragmentation and retrieval in-silico thrombec-tomy.(c) 2023 Elsevier B.V. All rights reserved.

KW - Thrombectomy

KW - Acute ischemic stroke

KW - Stent-retriever

KW - Finite element analysis

KW - MECHANICAL THROMBECTOMY

KW - PREDICTION

KW - GUIDEWIRE

KW - CLOT

U2 - 10.1016/j.cmpb.2023.107515

DO - 10.1016/j.cmpb.2023.107515

M3 - Article

C2 - 37011425

SN - 0169-2607

VL - 234

JO - Computer Methods and Programs in Biomedicine

JF - Computer Methods and Programs in Biomedicine

IS - 1

M1 - 107515

ER -

Microcatheter tracking in thrombectomy procedures: A finite-element simulation study

Abstract

Keywords

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