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

• Published in: Computer methods and programs in biomedicine 2023-06, Vol.234, p.107515-107515, Article 107515
• Main Authors: Arrarte Terreros, Nerea, Renon, Silvia, Zucchelli, Francesca, Bridio, Sara, Rodriguez Matas, Jose Felix, Dubini, Gabriele, Konduri, Praneeta R., Koopman, Miou S., van Zwam, Wim H., Yo, Lonneke S.F., Lo, Rob H., Marquering, Henk A., van Bavel, Ed, Majoie, Charles B.L.M., Migliavacca, Francesco, Luraghi, Giulia
• Format: Article
• Language: English
• Subjects: Acute ischemic stroke; Computer Simulation; Finite element analysis; Humans; Ischemic Stroke; Stent-retriever; Stroke - diagnostic imaging; Stroke - surgery; Thrombectomy; Thrombectomy - methods; Thrombosis - diagnostic imaging; Thrombosis - surgery; Treatment Outcome
• ISSN: 0169-2607; 1872-7565
• DOI: 10.1016/j.cmpb.2023.107515

•A new approach for modeling the microcatheter tracking during thrombectomy is proposed.•The catheter tracking simulations are qualitatively validated with clinical images of thrombectomy procedures.•Simulations of thrombectomy with different positions of the microcatheter resulted in different procedure outcomes.•The study highlights the importance of an accurate modeling of the microcatheter tracking. Mechanical thrombectomy is a minimally invasive procedure that aims at removing 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. For 3 patient-specific vessel geometries, we performed finite-element simulations of the microcatheter 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 compared simulated thrombectomy outcomes (successful vs unsuccessful thrombus retrieval) and maximum principal stresses on the thrombus between the centerline and tip-dragging method. Qualitative comparison with the DSA images showed that the tip-dragging method more realistically 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%. 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 thrombectomy.