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Computational simulations of thrombolysis in acute stroke: Effect of clot size and location on recanalisation

Gu, B; Piebalgs, A; Huang, Y; Roi, D; Lobotesis, K; Longstaff, C; Hughes, AD; ... Xu, XY; + view all (2019) Computational simulations of thrombolysis in acute stroke: Effect of clot size and location on recanalisation. Medical Engineering & Physics , 73 pp. 9-17. 10.1016/j.medengphy.2019.07.014. Green open access

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Abstract

Acute ischaemic stroke can be treated by intravenous thrombolysis whereby tissue plasminogen activator (tPA) is infused to dissolve clots that block blood supply to the brain. In this study, we aim to examine the influence of clot location and size on lysis pattern and recanalisation by using a recently developed computational modelling framework for thrombolysis under physiological flow conditions. An image-based patient-specific model is reconstructed which consists of the internal carotid bifurcation with the A1 segment of anterior cerebral arteries and M1 segment of middle cerebral arteries, and the M1 bifurcation containing the M2 segments. By varying the clot size and location, 7 scenarios are simulated mimicking thrombolysis of M1 and M2 occlusions. Our results show that initial breakthrough always occurs along the inner curvature of the occluded cerebral artery, due to prolonged tPA residence time in the recirculation zone. For a given occlusion site, lysis completion time appears to increase almost quadratically with the initial clot volume; whereas for a given clot volume, the simulated M2 occlusions take up to 30% longer for complete lysis compared to the corresponding M1 occlusions.

Type: Article
Title: Computational simulations of thrombolysis in acute stroke: Effect of clot size and location on recanalisation
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.medengphy.2019.07.014
Publisher version: https://doi.org/10.1016/j.medengphy.2019.07.014
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Blood clot, Computational model, Drug transport, Ischaemic stroke, Thrombolytic therapy, Tissue plasminogen activator (tPA)
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10080187
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