A clinical perspective on endovascular stroke treatment biomechanics

Johanna M. Ospel*, A. (Aad) van der Lugt, Matthew Gounis, Mayank Goyal, Charles B.L.M. Majoie

*Corresponding author for this work

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Abstract

Acute ischemic stroke (AIS) is caused by blockage of an arterial blood vessel in the brain by a thrombus, which interrupts oxygen supply to the brain parenchyma. The goal of endovascular stroke treatment (mechanical thrombectomy) is to restore blood flow as quickly and completely as possible. There are numerous factors that influence endovascular treatment success. They can be broadly grouped into a) factors related to blood vessels, b) factors related to the thrombus, c) factors related to endovascular treatment technique and tools and d) operator-related factors. While blood vessel and tgthro thrombus-related factors are mostly non-modifiable in the acute setting, operator and technique-related factors can be modified, and extensive research is currently being done to investigate the complex interplay of all these variables, and to optimize the modifiable factors to the maximum possible extent. In this review, we will describe these factors and how they interact with each other in detail, and outline some of their practical implications. We will conclude with a short summary and outlook on future directions for optimizing endovascular treatment success.

Original languageEnglish
Article number110694
JournalJournal of Biomechanics
Volume127
Early online date14 Aug 2021
DOIs
Publication statusPublished - 11 Oct 2021

Bibliographical note

Funding Information:
The authors want to thank Prof. Psychogios and Scott Bexton for their help with the figures. None. Mayank Goyal is a consultant (Medtronic, Stryker, Microvention, GE-Healthcare, Mentice). Charles Majoie is a Nicolab shareholder, and has received institutional grants (European Commission, TWIN, Stryker). Aad van der Lugt received research support from CVON/Dutch Heart Foundation, Dutch Brain Foundation, European Commission, Stryker, Medtronic, Penumbra, Cerenovus, Philips, Siemens, GE Healthcare, all paid to institution. Matthew Gounis has been a consultant on a fee-per-hour basis for Alembic Medical, Astrocyte Pharmaceuticals, BendIt Technologies, Cerenovous, Imperative Care, Medtronic Neurovascular, Mivi Neurosciences, Phenox, Q'Apel Medical, Route 92 Medical, Stryker Neurovascular, and Wallaby Medical; holds stock in Galaxy Medical, Imperative Care, InNeuroCo and Neurogami; and has received research support from National Institutes of Health (NIH), the United States ? Israel Binational Science Foundation, Anaconda, ApicBio, Arsenal Medical, Axovant, Cerenovus, Ceretrieve, Cook Medical, Galaxy Therapeutics, Gentuity, Imperative Care, InNeuroCo, Insera, Magneto, Microvention, Medtronic Neurovascular, MIVI Neurosciences, Naglreiter MDDO, Neurogami, phenox GmbH, Philips Healthcare, Progressive Medical, Rapid Medical, Route 92 Medical, Stryker Neurovascular, Syntheon, ThrombX Medical, the Wyss Institute and Xtract Medical.

Funding Information:
Mayank Goyal is a consultant (Medtronic, Stryker, Microvention, GE-Healthcare, Mentice). Charles Majoie is a Nicolab shareholder, and has received institutional grants (European Commission, TWIN, Stryker). Aad van der Lugt received research support from CVON/Dutch Heart Foundation, Dutch Brain Foundation, European Commission, Stryker, Medtronic, Penumbra, Cerenovus, Philips, Siemens, GE Healthcare, all paid to institution. Matthew Gounis has been a consultant on a fee-per-hour basis for Alembic Medical, Astrocyte Pharmaceuticals, BendIt Technologies, Cerenovous, Imperative Care, Medtronic Neurovascular, Mivi Neurosciences, Phenox, Q’Apel Medical, Route 92 Medical, Stryker Neurovascular, and Wallaby Medical; holds stock in Galaxy Medical, Imperative Care, InNeuroCo and Neurogami; and has received research support from National Institutes of Health (NIH), the United States – Israel Binational Science Foundation, Anaconda, ApicBio, Arsenal Medical, Axovant, Cerenovus, Ceretrieve, Cook Medical, Galaxy Therapeutics, Gentuity, Imperative Care, InNeuroCo, Insera, Magneto, Microvention, Medtronic Neurovascular, MIVI Neurosciences, Naglreiter MDDO, Neurogami, phenox GmbH, Philips Healthcare, Progressive Medical, Rapid Medical, Route 92 Medical, Stryker Neurovascular, Syntheon, ThrombX Medical, the Wyss Institute and Xtract Medical.

Publisher Copyright:
© 2021

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