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Research ArticleNeurointervention

In Vitro Analysis of the Efficacy of Endovascular Thrombectomy Techniques according to the Vascular Tortuosity Using 3D Printed Models

J.H. Kim, B.M. Kim and D.J. Kim
American Journal of Neuroradiology September 2022, DOI: https://doi.org/10.3174/ajnr.A7633
J.H. Kim
aFrom the Department of Radiology (J.H.K.), Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, Republic of Korea
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B.M. Kim
bDepartment of Radiology (B.M.K., D.J.K.), Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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D.J. Kim
bDepartment of Radiology (B.M.K., D.J.K.), Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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  • FIG 1.
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    FIG 1.

    CAD-processed 3D images of the nontortuous (A) and tortuous (B) cerebrovascular angiographic data. Silicone vascular models of the nontortuous (C) and tortuous (D) anatomy manufactured from the 3D printing models.

  • FIG 2.
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    FIG 2.

    A vascular model was placed in the acrylic tank and connected to the closed circuit. The black arrow indicates the flow model in a water-filled tank. The white arrow indicates a separate tank for collecting distal embolus. The white arrowhead indicates the peristaltic pump.

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    FIG 3.

    Mechanisms of thrombectomy failure in the tortuous anatomy model. A–C, Tortuous anatomy model. D–F, Nontortuous anatomy model. A, In the CA experiment, the thrombus is clogged at the tip of the aspiration catheter. The thrombus brushes against the tortuous vessel wall during retrieval and fragments when the aspiration catheter tip deflects perpendicular to the axis of the lumen at the angulated curve (white arrow, catheter tip alignment; black arrow, axis of the lumen and thrombus alignment). B, In the SR experiment, elongation and segmental collapse of the stent are noted (white arrows) when retrieving across the curved segment of the vessel, causing fragmentation of the thrombus. C, In the combined experiment, shearing of the thrombus occurred (white arrow) while crossing the curved segment when the SR was inadvertently pulled into the aspiration catheter during retrieval of the SR-CA unit due to aggravation of the length mismatch. D, In the CA experiment, the clogged thrombus and aspiration catheter show a more obtuse angle and are less deflected in the nontortuous anatomy model. E, The SR shows no elongation or segmental collapse at the curved segment of the vessel in the SR experiment, and there is no fragmentation or missing thrombus. F, In the combined experiment, the SR is not pulled into the aspiration catheter, and no shearing-off phenomenon is seen.

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    Table 1:

    Incidence of FPE and DE in nontortuous and tortuous models according to the EVT technique

    FPEDE
    NontortuousTortuousNontortuousTortuous
    Total12/15 (80.0%)7/15 (46.7%)4/15 (26.7%)7/15 (46.7%)
    CA5/5 (100.0%)4/5 (80.0%)0/5 (0%)1/5 (20.0%)
    SR4/5 (80.0%)2/5 (40.0%)1/5 (20.0%)3/5 (60.0%)
    Combined3/5 (60.0%)1/5 (20.0%)3/5 (60.0%)3/5 (60.0%)
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    Table 2:

    Incidence of failure of complete recanalization in nontortuous and tortuous models according to the EVT technique

    Failure of Complete Recanalization
    NontortuousTortuous
    Total5/15 (33.3%)9/15 (60.0%)
    CA0/5 (0%)1/5 (20.0%)
    SR2/5 (40.0%)4/5 (80.0%)
    Combined3/5 (60.0%)4/5 (80.0%)
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Cite this article
J.H. Kim, B.M. Kim, D.J. Kim
In Vitro Analysis of the Efficacy of Endovascular Thrombectomy Techniques according to the Vascular Tortuosity Using 3D Printed Models
American Journal of Neuroradiology Sep 2022, DOI: 10.3174/ajnr.A7633

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In Vitro Analysis of the Efficacy of Endovascular Thrombectomy Techniques according to the Vascular Tortuosity Using 3D Printed Models
J.H. Kim, B.M. Kim, D.J. Kim
American Journal of Neuroradiology Sep 2022, DOI: 10.3174/ajnr.A7633
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