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Purpose: The increased demand for training of mechanical thrombectomy in ischemic stroke and development of new recanalization devices urges the creation of new simulation models both for training and device assessment. Clots properties have shown to play a role in procedural planning and thrombectomy device effectiveness. In this study, we analyzed the characteristics and applicability of completely synthetic, animal-free clots in the setting of an in-vitro model of mechanical thrombectomy for training and device assessment.
Methods: Synthetic clots based on agarose (n = 12) and silicone (n = 11) were evaluated in an in-vitro neurointervention simulation of mechanical thrombectomy with clot extraction devices. Calcified clots of mixed nature were simulated with addition of 3D printed structures. 9 clots were excluded due to insufficient vessel occlusion and failure to integrate with clot extraction device. Synthetic thrombi were characterized and compared using a categorical score-system on vessel occlusion, elasticity, fragmentation, adherence and device integration.
Results: Both agarose-based and silicone-based clots demonstrated relevant flow arrest and a good integration with the clot extraction device. Silicone-based clots scored higher on adherence to the vessel wall and elasticity.
Conclusion: Selected synthetic clots can successfully be implemented in an in-vitro training environment of mechanical thrombectomy. The clots' different properties might serve to mimic fibrin-rich and red blood cell-rich human thrombi.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9462564 | PMC |
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0274211 | PLOS |
Ther Hypothermia Temp Manag
December 2024
Department of Cerebrovascular Diseases, Suining Central Hospital, Sichuan Province, China.
The application value of mechanical thrombectomy (MT) in acute large-vessel occlusion cerebral infarction has been confirmed, but considering the poor prognosis of large-core infarction (LCI), the current guidelines and practices are based on anterior circulation small-core infarction. Reducing the perioperative complications of thrombectomy in LCIs is the key to saving more patients previously considered unsuitable for thrombectomy. Patients with acute anterior circulation cerebral infarction who were admitted to Suining Central Hospital of Sichuan Province from January 2022 to December 2023 and whose Alberta Stroke Program Early Computed Tomography Score value was 3-5 (the score range was 0-10, and the lower the score was, the larger the infarct area) or whose infarct core volume was ≥70 mL and who received MT were enrolled consecutively.
View Article and Find Full Text PDFLancet Reg Health Am
January 2025
Neurology and Neurosurgery Department Hospital Moinhos de Vento, Porto Alegre, RS, Brazil.
Background: Current literature highlights a gap in precise stroke cost data for Latin America. This study measures the real costs associated with acute ischemic stroke care in Latin America using Time-Driven Activity-Based Costing (TDABC). The findings aim to lay a solid foundation for adopting value-based healthcare (VBHC) strategies in the region.
View Article and Find Full Text PDFNeurologia (Engl Ed)
December 2024
Servicio de Neurología, Hospital Universitario Navarra, Pamplona, Navarra, Spain; RICORS-ICTUS, ISCIII, Madrid, Spain.
Introduction: Since mechanical thrombectomy has allowed ischemic stroke thrombi retrieval, its exhaustive study has involved a better knowledge of physiopathological processes implied in its formation.
Development: Thrombotic pathways involved in the different vascular beds shared common mechanisms conditioning difficulties in the identification of specific patterns associated with stroke etiology. Other factors as clot formation time, associated inflammatory status or activation of additional immune and coagulation pathways [Neutrophil extracellular traps (NETs) delivery, platelet aggregation, endothelial activation and VonWillebrand Factor release] have been described as determinants in thrombus characteristics.
Hypertens Res
December 2024
Stroke Center, Department of Neurology, The First Hospital of Jilin University, Chang Chun, China.
The relationship of beat-to-beat blood pressure variability (BPV) with prognosis after mechanical thrombectomy (MT) is unclear. Consecutive patients with acute ischemic stroke with large vessel occlusion treated with and without MT matched 1:1 by age, sex, and National Institutes of Health Stroke Scale were included. Beat-to-beat BPV was calculated for both systolic (SBP) and diastolic blood pressure (DBP) as standard deviation, coefficient of variation, successive variation (SV), and average real variability (ARV) at 24-72 h after MT.
View Article and Find Full Text PDFJ Neurointerv Surg
December 2024
Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
Background: Despite successful recanalization via mechanical thrombectomy (MT), only half of acute ischemic stroke (AIS) patients achieve functional independence. Post-MT hemodynamic features are insufficiently investigated, and the lack of bilateral comparisons limits individual assessment. Therefore, we aimed to explore how individualized hemodynamic features affect functional outcomes using quantitative digital subtraction angiography (Q-DSA).
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