PT - JOURNAL ARTICLE AU - Y. Liu AU - J.L.A. Larco AU - S.I. Madhani AU - A.H. Shahid AU - R.A. Quinton AU - R. Kadirvel AU - D.F. Kallmes AU - W. Brinjikji AU - L.E. Savastano TI - A Thrombectomy Model Based on Ex Vivo Whole Human Brains AID - 10.3174/ajnr.A7291 DP - 2021 Nov 01 TA - American Journal of Neuroradiology PG - 1968--1972 VI - 42 IP - 11 4099 - http://www.ajnr.org/content/42/11/1968.short 4100 - http://www.ajnr.org/content/42/11/1968.full SO - Am. J. Neuroradiol.2021 Nov 01; 42 AB - BACKGROUND AND PURPOSE: The persistent challenges in thrombectomy for large-vessel occlusion, such as suboptimal complete recanalization and first-pass effect imply an insufficient understanding of the artery-clot-device interaction. In this study, we present a thrombectomy model using fresh human brains, which can capture the artery-clot-device interaction through concurrent transmural and angiographic visualizations.MATERIALS AND METHODS: Fresh nonfrozen whole adult human brains were collected and connected to a customized pump system tuned to deliver saline flow at a physiologic flow rate and pressure. Angiography was performed to verify the flow in the anterior-posterior and vertebrobasilar circulations and collaterals. Large-vessel occlusion was simulated by embolizing a radiopaque clot analog. Thrombectomy was tested, and the artery-clot-device interactions were recorded by transmural and angiographic videos.RESULTS: Baseline cerebral angiography revealed excellent penetration of contrast in the anterior-posterior and vertebrobasilar circulations without notable arterial cutoffs and with robust collaterals. Small branches (<0.5 mm) and perforating arteries were consistently opacified with good patency. Three device passes were performed to achieve recanalization, with failure modes including elongation, fragmentation, and distal embolization.CONCLUSIONS: This model enables concurrent transmural and angiographic analysis of artery-clot-device interaction in a human brain and provides critical insights into the action mechanism and failure modes of current and upcoming thrombectomy devices.LVOlarge-vessel occlusionVAvertebral artery