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 journalArticleAcademicpeer-review


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 languageEnglish
Article number107515
Number of pages10
JournalComputer Methods and Programs in Biomedicine
Publication statusPublished - 1 Jun 2023


  • Thrombectomy
  • Acute ischemic stroke
  • Stent-retriever
  • Finite element analysis
  • CLOT

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