Background Collateral blood supply of distal vessels has been linked to clinical outcome, infarct volume and recanalization rates in patients with large vessel occlusion. Our study aimed to explore the effects of catheterization during mechanical thrombectomy in collaterals.
Methods We quantified the flow diversion effect secondary to arterial occlusions in an in vitro model which was connected in a flow-loop setup with a saline reservoir and a pump supplying pulsatile flow. Clot analogs were embolized to the middle cerebral artery (MCA) M1 or M2 segments. We used the same model with a clamped anterior communicating artery (AComA) to simulate its absence. An ultrasound flow sensor was placed at the vessel of interest. Flow rates and pressures were evaluated according to the following catheter locations: baseline (1) before and (2) after the occlusion; (3) 8F guiding catheter at the internal carotid artery (ICA) bulb; (4) at the cavernous segment; (5) at the cavernous segment a 0.071” distal access catheter at proximal M1; (6) 8F balloon guide catheter inflated.
Results Collateral blood flow measured at distal anterior cerebral artery (ACA) (M1-MCA occlusion) and M2-MCA (M2-MCA occlusion) was progressively reduced as catheters were advanced through the ICA and MCA. In the lacking AComA model, the flow was further diminished as compared with the model with a patent AComA.
Conclusion Our in vitro study showed a progressive reduction of collateral blood flow due to the advance of catheters during mechanical thrombectomy.
Data availability statement
Data are available upon reasonable request. Data for collaborative studies can be obtained by contacting the corresponding author.
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Contributors JL, RT, PC, MOG and MRi directly participated in the experiments and recorded data. MReq, JL and MRi wrote the first draft of the manuscript. JL and MReq designed the figures. All authors performed a critical review of the study.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests AT reported receiving personal fees from Anaconda Biomed, Balt, Medtronic, Perflow, and Stryker outside the submitted work. MRi reported receiving personal fees from Anaconda Biomed, AptaTargets, Cerenovus, Johnson & Johnson, Medtronic, Methinks, Philips, Sanofi, Stryker, and Rapid AI outside the submitted work and is co-principal investigator of the WE-TRUST trial (NCT04701684).
Provenance and peer review Not commissioned; externally peer reviewed.
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