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

Sara Bridio,Patrick Mcgarry,Praneeta R Konduri,Ed Van Bavel,Greta Maggio,Kevin M Moerman,Giorgia G Giassi,Charles B L M Majoie,Nerea Arrarte Terreros,Julia N Kawamoto,Henk A Marquering,Gabriele Dubini,Jose F Rodriguez Matas,Francesco Migliavacca,Giulia Luraghi

doi:10.3389/fmedt.2021.719909

Abstract

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.

Highlights

The intra-arterial thrombectomy is a minimally invasive procedure based on stent-retriever technology for acute ischemic stroke (AIS) patients
The carotid siphon lies between the carotid canal and the T-junction, where the internal carotid artery (ICA) bifurcates into the middle cerebral artery (MCA) and the anterior cerebral artery (ACA) (Figure 1A)
In the successful thrombectomy simulations the clots remained captured in the stentretriever during the retrieval phase and reached the end of the ICA segment (Figure 8-top)

Summary

Introduction

The intra-arterial thrombectomy is a minimally invasive procedure based on stent-retriever technology for acute ischemic stroke (AIS) patients. An AIS arises when a large vessel occlusion caused by a thromboembolus (clot) prevents blood supply to the brain tissues. The most likely location of the AIS is the intracranial internal carotid artery (ICA) and its bifurcated downstream segments. The main individual variability in ICA geometry can be found in the so-called carotid siphon [3]. The carotid siphon lies between the carotid canal and the T-junction, where the ICA bifurcates into the middle cerebral artery (MCA) and the anterior cerebral artery (ACA) (Figure 1A). Four different bends can be recognized in the ICA [4, 5]: (from the carotid canal) inferior, posterior, anterior, and superior (Figure 1B)

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