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Original research
Impact on collateral flow of devices used for endovascular treatment of stroke: an in-vitro flow model
  1. Manuel Requena1,2,3,
  2. Jiahui Li3,4,
  3. Riccardo Tiberi3,5,
  4. Pere Canals3,
  5. Marta Olive Gadea1,3,
  6. Marta de Dios Lascuevas2,3,
  7. Magda Jabłońska3,6,
  8. Judith Cendrero1,3,
  9. Alvaro Garcia-Tornel1,3,
  10. Alejandro Tomasello1,3,
  11. Marc Ribo1,3,4
  1. 1Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
  2. 2Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
  3. 3Stroke Research, Vall d'Hebron Research Institute, Barcelona, Spain
  4. 4Department of Neurology, Autonomous University of Barcelona, Barcelona, Spain
  5. 5Universitat Politècnica de Catalunya, Barcelona, Spain
  6. 6Department of Radiology, Gdanski Uniwersytet Medyczny, Gdansk, Poland
  1. Correspondence to Dr Marc Ribo, Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona 08035, Spain; marcriboj{at}


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.

  • stroke
  • thrombectomy
  • catheter

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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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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  • Twitter @marcriboj

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.