A human brain test bed for research in large vessel occlusion stroke

View More View Less
  • 1 Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan;
  • | 2 UC Berkeley–UCSF Graduate Program in Bioengineering, San Francisco, California;
  • | 3 Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan;
  • | 4 Department of Radiology, Mayo Clinic, Rochester, Minnesota;
  • | 5 Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts; and
  • | 6 Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

OBJECTIVE

Endovascular removal of emboli causing large vessel occlusion (LVO)–related stroke utilizing suction catheter and/or stent retriever technologies or thrombectomy is a new standard of care. Despite high recanalization rates, 40% of stroke patients still experience poor neurological outcomes as many cases cannot be fully reopened after the first attempt. The development of new endovascular technologies and techniques for mechanical thrombectomy requires more sophisticated testing platforms that overcome the limitations of phantom-based simulators. The authors investigated the use of a hybrid platform for LVO stroke constructed with cadaveric human brains.

METHODS

A test bed for embolic occlusion of cerebrovascular arteries and mechanical thrombectomy was developed with cadaveric human brains, a customized hydraulic system to generate physiological flow rate and pressure, and three types of embolus analogs (elastic, stiff, and fragment-prone) engineered to match mechanically and phenotypically the emboli causing LVO strokes. LVO cases were replicated in the anterior and posterior circulation, and thrombectomy was attempted using suction catheters and/or stent retrievers.

RESULTS

The test bed allowed radiation-free visualization of thrombectomy for LVO stroke in real cerebrovascular anatomy and flow conditions by transmural visualization of the intraluminal elements and procedures. The authors were able to successfully replicate 105 LVO cases with 184 passes in 12 brains (51 LVO cases and 82 passes in the anterior circulation, and 54 LVO cases and 102 passes in the posterior circulation). Observed recanalization rates in this model were graded using a Recanalization in LVO (RELVO) scale analogous to other measures of recanalization outcomes in clinical use.

CONCLUSIONS

The human brain platform introduced and validated here enables the analysis of artery-embolus-device interaction under physiological hemodynamic conditions within the unmodified complexity of the cerebral vasculature inside the human brain.

ABBREVIATIONS

ACA = anterior cerebral artery; ACOM = anterior communicating artery; BA = basilar artery; DA = direct aspiration; EA = embolus analog; ICA = internal carotid artery; LVO = large vessel occlusion; MCA = middle cerebral artery; mTICI = modified Thrombolysis In Cerebral Infarction; PCA = posterior cerebral artery; RBC = red blood cell; RELVO = Recanalization in LVO; SR+A = stent retriever + aspiration; VA = vertebral artery.

Illustration from Kim et al. (pp 1164–1172). Copyright Eui Hyun Kim. Published with permission.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Palaniswami M, Yan B. Mechanical thrombectomy is now the gold standard for acute ischemic stroke: implications for routine clinical practice. Intervent Neurol. 2015;4(1-2):1829.

    • Search Google Scholar
    • Export Citation
  • 2

    Kleine JF, Wunderlich S, Zimmer C, Kaesmacher J. Time to redefine success? TICI 3 versus TICI 2b recanalization in middle cerebral artery occlusion treated with thrombectomy. J Neurointerv Surg. 2017;9(2):117121.

    • Search Google Scholar
    • Export Citation
  • 3

    Zaidat OO, Castonguay AC, Linfante I, et al. First pass effect: a new measure for stroke thrombectomy devices. Stroke. 2018;49(3):660666.

  • 4

    Klinger-Gratz PP, Schroth G, Gralla J, et al. Protected stent retriever thrombectomy prevents iatrogenic emboli in new vascular territories. Neuroradiology. 2015;57(10):10451054.

    • Search Google Scholar
    • Export Citation
  • 5

    Kurre W, Vorlaender K, Aguilar-Pérez M, et al. Frequency and relevance of anterior cerebral artery embolism caused by mechanical thrombectomy of middle cerebral artery occlusion. AJNR Am J Neuroradiol. 2013;34(8):16061611.

    • Search Google Scholar
    • Export Citation
  • 6

    Saver JL. Time is brain—quantified. Stroke. 2006;37(1):263266.

  • 7

    Yoo AJ, Andersson T. Thrombectomy in acute ischemic stroke: challenges to procedural success. J Stroke. 2017;19(2):121130.

  • 8

    Gounis MJ, Wakhloo AK, Chueh JY. Preclinical investigations for thrombectomy devices—does it translate to humans? Stroke. 2013;44(6)(suppl 1):S7S10.

    • Search Google Scholar
    • Export Citation
  • 9

    Reddy AS, Liu Y, Cockrum J, et al. Construction of a comprehensive endovascular test bed for research and device development in mechanical thrombectomy in stroke. J Neurosurg. Published online April 3, 2020. doi:10.3171/2020.1.JNS192732

    • Search Google Scholar
    • Export Citation
  • 10

    Tanaka H, Fujita N, Enoki T, et al. Relationship between variations in the circle of Willis and flow rates in internal carotid and basilar arteries determined by means of magnetic resonance imaging with semiautomated lumen segmentation: reference data from 125 healthy volunteers. AJNR Am J Neuroradiol. 2006;27(8):17701775.

    • Search Google Scholar
    • Export Citation
  • 11

    Liu Y, Zheng Y, Reddy AS, et al. Analysis of human emboli and thrombectomy forces in large-vessel occlusion stroke. J Neurosurg. Published online February 28, 2020. doi:10.3171/2019.12.JNS192187

    • Search Google Scholar
    • Export Citation
  • 12

    Shin JW, Jeong HS, Kwon HJ, et al. High red blood cell composition in clots is associated with successful recanalization during intra-arterial thrombectomy. PLoS One. 2018;13(5):e0197492.

    • Search Google Scholar
    • Export Citation
  • 13

    Liu Y, Reddy A, Cockrum J, et al. Standardized fabrication method of human-derived emboli with histologic and mechanical quantification for stroke research. J Stroke Cerebrovasc Dis. 2020;29(11):105205.

    • Search Google Scholar
    • Export Citation
  • 14

    Gratz PP, Schroth G, Gralla J, et al. Whole-brain susceptibility-weighted thrombus imaging in stroke: Fragmented thrombi predict worse outcome. AJNR Am J Neuroradiol. 2015;36(7):12771282.

    • Search Google Scholar
    • Export Citation
  • 15

    Fargen KM, Arthur AS, Spiotta AM, et al. A survey of neurointerventionalists on thrombectomy practices for emergent large vessel occlusions. J Neurointerv Surg. 2017;9(2):142146.

    • Search Google Scholar
    • Export Citation
  • 16

    Kleine JF, Boeckh-Behrens T, Prothmann S, et al. Discrepancy between early neurological course and mid-term outcome in older stroke patients after mechanical thrombectomy. J Neurointerv Surg. 2016;8(7):671676.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 46 46 46
Full Text Views 57 57 57
PDF Downloads 87 87 87
EPUB Downloads 0 0 0