A novel methodology for the modeling of catheter aspiration in high-fidelity thrombectomy simulations

The development of high-fidelity in silico simulations of the endovascular thrombectomy (EVT) procedure, the treatment for acute ischemic stroke, is gaining importance for the possibility of investigating the causes of failure of the clinical procedure and optimizing the treatment. This work proposed a novel methodology for a realistic modeling of the thrombus aspiration in a combined EVT procedure, with stent-retriever and proximal aspiration catheter. In the combined EVT procedure, the thrombus is entrapped in the stent struts and is retrieved towards the aspiration catheter. During the retrieval, the thrombus may rotate, and therefore different portions of its surface are subjected to aspiration forces. An automatic algorithm is implemented allowing to redefine the portion of the thrombus surface subjected to the aspiration pressure in different time points of a high-fidelity finite-element EVT simulation. The algorithm updates at each iteration the loaded portion of thrombus surface, by selecting elements aligned with the vascular centerline. The algorithm is applied in a high-fidelity EVT simulation in a patient-like vascular model, demonstrating the ability of obtaining a realistic simulation of thrombus aspiration.