Computer Modeling of Clot Retrieval—Circle of Willis

Endovascular clot retrieval, often referred to as mechanical thrombectomy, has transformed the treatment of patients with ischemic stroke based on an underlying large cerebral vessel occlusion, ranging from the extracranial internal carotid artery (ICA) to the M1 (proximal) segment of the middle cer...

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Main Authors: Thanh G. Phan, Henry Ma, Mayank Goyal, James Hilton, Matthew Sinnott, Velandai Srikanth, Richard Beare
Format: Article
Language:English
Published: Frontiers Media S.A. 2020-08-01
Series:Frontiers in Neurology
Subjects:
Online Access:https://www.frontiersin.org/article/10.3389/fneur.2020.00773/full
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spelling doaj-25611864a9514c99a95c33f7cee234a32020-11-25T03:04:29ZengFrontiers Media S.A.Frontiers in Neurology1664-22952020-08-011110.3389/fneur.2020.00773549305Computer Modeling of Clot Retrieval—Circle of WillisThanh G. Phan0Thanh G. Phan1Henry Ma2Henry Ma3Mayank Goyal4James Hilton5Matthew Sinnott6Velandai Srikanth7Richard Beare8Stroke and Aging Research Group, Clinical Trials, Imaging and Informatics Division, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, AustraliaDepartment of Neurology, Monash Health, Melbourne, VIC, AustraliaStroke and Aging Research Group, Clinical Trials, Imaging and Informatics Division, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, AustraliaDepartment of Neurology, Monash Health, Melbourne, VIC, AustraliaDepartments of Clinical Neuroscience and Radiology, Cummings School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, CanadaData 61, CSIRO, Innovation Hub, Docklands, VIC, AustraliaData 61, CSIRO, Innovation Hub, Docklands, VIC, AustraliaDepartment of Medicine, Peninsula Clinical School, Central Clinical School, Frankston Hospital, Monash University, Melbourne, VIC, AustraliaDepartments of Clinical Neuroscience and Radiology, Cummings School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, CanadaEndovascular clot retrieval, often referred to as mechanical thrombectomy, has transformed the treatment of patients with ischemic stroke based on an underlying large cerebral vessel occlusion, ranging from the extracranial internal carotid artery (ICA) to the M1 (proximal) segment of the middle cerebral artery (MCA). The aim of this study was to evaluate the effect of a progressive occlusion of the extracranial portion of the ICA on the cerebral blood flow either with a conventional guiding catheter or a balloon-guiding catheter, which enables the operator to completely occlude the parent artery by inflating the balloon around the tip of this type of guiding catheter. We evaluated the impact of flow reduction in the ICA in the setting of ipsilateral MCA occlusion given the different configurations of the circle of Willis (CoW). The computer model of cerebral arteries was based on anatomical works by Rhoton (1) and van der Eecken (2). The interactive experimental results are available on the web at https://gntem3.shinyapps.io/ecrsim. In the setting of left MCA occlusion, compensation from the anterior and posterior communicating artery preserved the flow in the left anterior cerebral artery (ACA) but not the left MCA branches. Under selected CoW configurations, such as classic, missing Acom, or missing A1 segment of the ACA and concurrent right ICA occlusion, there was a progressive decrease of flow in the left ACA to a minimum of 78% when the simulated catheter fully occluded the left ICA. Flow collapsed (<10%) in the left ACA and MCA branches under CoW configurations, such as bilateral fetal PCA. In summary, compensatory flow collapsed under certain clot retrieval scenarios and unusual configurations of CoW.https://www.frontiersin.org/article/10.3389/fneur.2020.00773/fullcircle of Willisleptomeningeal anastomosesthrombectomysimulationstrokecarotid endarterectomy
collection DOAJ
language English
format Article
sources DOAJ
author Thanh G. Phan
Thanh G. Phan
Henry Ma
Henry Ma
Mayank Goyal
James Hilton
Matthew Sinnott
Velandai Srikanth
Richard Beare
spellingShingle Thanh G. Phan
Thanh G. Phan
Henry Ma
Henry Ma
Mayank Goyal
James Hilton
Matthew Sinnott
Velandai Srikanth
Richard Beare
Computer Modeling of Clot Retrieval—Circle of Willis
Frontiers in Neurology
circle of Willis
leptomeningeal anastomoses
thrombectomy
simulation
stroke
carotid endarterectomy
author_facet Thanh G. Phan
Thanh G. Phan
Henry Ma
Henry Ma
Mayank Goyal
James Hilton
Matthew Sinnott
Velandai Srikanth
Richard Beare
author_sort Thanh G. Phan
title Computer Modeling of Clot Retrieval—Circle of Willis
title_short Computer Modeling of Clot Retrieval—Circle of Willis
title_full Computer Modeling of Clot Retrieval—Circle of Willis
title_fullStr Computer Modeling of Clot Retrieval—Circle of Willis
title_full_unstemmed Computer Modeling of Clot Retrieval—Circle of Willis
title_sort computer modeling of clot retrieval—circle of willis
publisher Frontiers Media S.A.
series Frontiers in Neurology
issn 1664-2295
publishDate 2020-08-01
description Endovascular clot retrieval, often referred to as mechanical thrombectomy, has transformed the treatment of patients with ischemic stroke based on an underlying large cerebral vessel occlusion, ranging from the extracranial internal carotid artery (ICA) to the M1 (proximal) segment of the middle cerebral artery (MCA). The aim of this study was to evaluate the effect of a progressive occlusion of the extracranial portion of the ICA on the cerebral blood flow either with a conventional guiding catheter or a balloon-guiding catheter, which enables the operator to completely occlude the parent artery by inflating the balloon around the tip of this type of guiding catheter. We evaluated the impact of flow reduction in the ICA in the setting of ipsilateral MCA occlusion given the different configurations of the circle of Willis (CoW). The computer model of cerebral arteries was based on anatomical works by Rhoton (1) and van der Eecken (2). The interactive experimental results are available on the web at https://gntem3.shinyapps.io/ecrsim. In the setting of left MCA occlusion, compensation from the anterior and posterior communicating artery preserved the flow in the left anterior cerebral artery (ACA) but not the left MCA branches. Under selected CoW configurations, such as classic, missing Acom, or missing A1 segment of the ACA and concurrent right ICA occlusion, there was a progressive decrease of flow in the left ACA to a minimum of 78% when the simulated catheter fully occluded the left ICA. Flow collapsed (<10%) in the left ACA and MCA branches under CoW configurations, such as bilateral fetal PCA. In summary, compensatory flow collapsed under certain clot retrieval scenarios and unusual configurations of CoW.
topic circle of Willis
leptomeningeal anastomoses
thrombectomy
simulation
stroke
carotid endarterectomy
url https://www.frontiersin.org/article/10.3389/fneur.2020.00773/full
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