Computational simulations of thrombolysis in acute stroke: Effect of clot size and location on recanalisation. (November 2019)

• Record Type: Journal Article
• Authors: Gu, Boram; Piebalgs, Andris; Huang, Yu; Roi, Dylan; Lobotesis, Kyriakos; Longstaff, Colin; Hughes, Alun D.; Chen, Rongjun; Thom, Simon A.; Xu, Xiao Yun
• Is Part Of: Medical engineering & physics. Volume 73(2019)
• Page Start: 9
• Page End: 17
• Publication Date: 2019-11
• Subjects: Ischaemic stroke -- Thrombolytic therapy -- Blood clot -- Tissue plasminogen activator (tPA) -- Computational model -- Drug transport; Biomedical engineering -- Periodicals; Biomedical Engineering -- Periodicals; Physics -- Periodicals; Génie biomédical -- Périodiques; Biomedical engineering; Electronic journals; Periodicals; 610.28
• DOI: 10.1016/j.medengphy.2019.07.014
• Languages: English
• ISSNs: 1350-4533

Abstract

Highlights: A multi-level computational model is used to simulate thrombolytic therapy in ischaemic stroke. The clot lysis model accounts for realistic anatomy, physiological flow and drug transport. Clot size and location have a strong influence on lysis pattern and recanalization time. Vessel curvature influences the breakthrough pathway and lysis rate. Abstract: Acute ischaemic stroke can be treated by intravenous thrombolysis whereby tissue plasminogen activator (tPA) is infused to dissolve clots that block blood supply to the brain. In this study, we aim to examine the influence of clot location and size on lysis pattern and recanalisation by using a recently developed computational modelling framework for thrombolysis under physiological flow conditions. An image-based patient-specific model is reconstructed which consists of the internal carotid bifurcation with the A1 segment of anterior cerebral arteries and M1 segment of middle cerebral arteries, and the M1 bifurcation containing the M2 segments. By varying the clot size and location, 7 scenarios are simulated mimicking thrombolysis of M1 and M2 occlusions. Our results show that initial breakthrough always occurs along the inner curvature of the occluded cerebral artery, due to prolonged tPA residence time in the recirculation zone. For a given occlusion site, lysis completion time appears to increase almost quadratically with the initial clot volume; whereas for a given clot volume, the simulated M2 occlusions take up to 30% longer for complete lysis compared to the corresponding M1 occlusions.