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Flow reduction due to arterial catheterization during stroke treatment - A computational study using a distributed

Aseem Pradhan1, Fernando Mut1, Medhini Sosale1

  • 1Bioengineering Department, George Mason University, Fairfax, Virginia, USA.

International Journal for Numerical Methods in Biomedical Engineering
|August 2, 2024
PubMed
Summary

Catheterization during stroke treatment may reduce blood flow by up to 45% in affected brain regions. This risk is higher in patients with poor collateral circulation, impacting treatment effectiveness.

Keywords:
catheter insertioncollateral circulationcomputational hemodynamicsdistributed compartment modelendovascular interventionsstroke treatment

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Area of Science:

  • Biomedical Engineering
  • Neurology
  • Medical Imaging

Background:

  • Cerebral vasculature and collateral networks are crucial for stroke treatment efficacy.
  • Ischemic stroke treatments often involve catheterization, but its impact on blood flow has been understudied.
  • Collateral pathways, including the Circle of Willis and leptomeningeal arteries, are vital for maintaining brain perfusion during primary vessel obstruction.

Purpose of the Study:

  • To investigate the potential for reduced blood flow in the brain due to catheterization during ischemic stroke treatment.
  • To quantify the impact of catheter insertion on cerebral blood flow in various collateralization scenarios.
  • To validate a novel 0D model for simulating blood flow alterations during stroke interventions.

Main Methods:

  • Developed and validated a 0D lumped parameter model for catheterized blood vessels.
  • Validated the 0D model against experimental and 1D model benchmarks.
  • Compared 0D model results with 3D simulations of off-center catheter trajectories.
  • Simulated blood flow in realistic cerebral arterial networks with varying collateralization during M1 middle cerebral artery occlusion.

Main Results:

  • The 0D model accurately represented catheter effects, with minimal differences compared to 3D simulations.
  • Simulations revealed maximum blood flow reductions of up to 45% in the affected brain region.
  • The degree of flow reduction was significantly influenced by the patient's collateralization status.

Conclusions:

  • Catheterization, a standard stroke treatment, can significantly reduce blood flow to the ischemic brain.
  • Patients with insufficient collateral blood supply are at a higher risk of experiencing detrimental flow reductions during catheter-based interventions.
  • These findings highlight the need to consider collateral status when assessing the risks and benefits of catheterization in stroke treatment.