Flow control in the middle cerebral artery during thrombectomy: the effect of anatomy, catheter size and tip location
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Updated: Sep 27, 2025
Simulator Training for Endovascular Neurosurgery
Published on: May 6, 2020
Michael Neidlin1, Ehsan Yousefian2, Claudio Luisi1
1Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Nordrhein-Westfalen, Germany.
Insights
Choosing a larger aspiration catheter and placing it in the middle cerebral artery improves flow control during stroke treatment. Circle of Willis anatomy significantly impacts these outcomes.
Area of Science:
- Neuroendovascular procedures
- Cerebrovascular diseases
- Computational fluid dynamics
Background:
- Catheter size, placement, and Circle of Willis (CoW) anatomy influence flow dynamics in endovascular stroke therapy.
- Understanding these factors is crucial for optimizing treatment outcomes.
Purpose of the Study:
- To investigate the impact of catheter size, location, and CoW variations on flow control in the middle cerebral artery (MCA) during endovascular stroke treatment.
- To utilize a computational model based on 100 patient datasets for this analysis.
Main Methods:
- Created 3D computational models of the CoW from patient data (n=100) undergoing mechanical thrombectomy for acute ischemic stroke.
- Simulated flow control in the MCA under 48 different scenarios, varying catheter size, location, and collateral vessel configurations.
Main Results:
- Flow reversal using distal aspiration catheters was limited in the internal carotid artery and inconsistent in the MCA (14/48 cases).
- Larger catheters (Catalyst 7) were more effective for flow reversal than smaller ones (Catalyst 5, 6; p<0.001).
- Anatomical variations, particularly the absence of communicating arteries, significantly altered flow direction (p=0.028), with flow reversal rarely achieved in complete CoW anatomy.
Conclusions:
- Optimal flow control in aspiration thrombectomy is achieved by using the largest feasible aspiration catheter positioned in the MCA.
- Collateral flow can impede aspiration effectiveness, highlighting the importance of considering individual Circle of Willis anatomy during treatment planning.
Background:
Catheter size, location and circle of Willis anatomy impact the flow conditions during interventional stroke therapy. The aim of the study was to systematically investigate the influence of these factors on flow control in the middle cerebral artery by means of a computational model based on 100 patients with stroke who received endovascular treatment.
Methods:
The dimensions of the cervical and intracranial cerebral arteries of 100 patients who received endovascular mechanical thrombectomy for acute ischemic stroke were measured and a three-dimensional model of the circle of Willis was created based on these data. Flow control in the middle cerebral artery with variations in catheter size, catheter location and configurations of collateral vessels was determined using a computational model. A total of 48 scenarios were analyzed.
Results:
Flow reversal with a distal aspiration catheter alone was not possible in the internal carotid artery and only sometimes possible in the middle cerebral artery (14 of 48 cases). The Catalyst 7 catheter was more often successful in achieving flow reversal than Catalyst 5 or 6 catheters (p<0.001). In a full circle of Willis anatomy, flow reversal was almost never possible. The absence of one or more communicating arteries significantly influenced flow direction compared with the full anatomy with all communicating arteries present (p=0.028).
Conclusion:
Choosing the biggest possible aspiration catheter and locating it in the middle cerebral artery significantly increases the chances of successful flow control. Flow through the collaterals may impair the flow, and circle of Willis anatomy should be considered during aspiration thrombectomy.
