{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T03:59:52Z","timestamp":1778039992836,"version":"3.51.4"},"update-to":[{"DOI":"10.1371\/journal.pcbi.1008515","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,3,24]],"date-time":"2021-03-24T00:00:00Z","timestamp":1616544000000}}],"reference-count":58,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,12]],"date-time":"2021-03-12T00:00:00Z","timestamp":1615507200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union's Horizon 2020 Research and Innovation Programme","award":["777072"],"award-info":[{"award-number":["777072"]}]},{"name":"European Union's Horizon 2020 Research and Innovation Programme","award":["777072"],"award-info":[{"award-number":["777072"]}]},{"name":"European Union's Horizon 2020 Research and Innovation Programme","award":["777072"],"award-info":[{"award-number":["777072"]}]}],"content-domain":{"domain":["www.ploscompbiol.org"],"crossmark-restriction":false},"short-container-title":["PLoS Comput Biol"],"abstract":"<jats:p>Many ischaemic stroke patients who have a mechanical removal of their clot (thrombectomy) do not get reperfusion of tissue despite the thrombus being removed. One hypothesis for this \u2018no-reperfusion\u2019 phenomenon is micro-emboli fragmenting off the large clot during thrombectomy and occluding smaller blood vessels downstream of the clot location. This is impossible to observe in-vivo and so we here develop an in-silico model based on in-vitro experiments to model the effect of micro-emboli on brain tissue. Through in-vitro experiments we obtain, under a variety of clot consistencies and thrombectomy techniques, micro-emboli distributions post-thrombectomy. Blood flow through the microcirculation is modelled for statistically accurate voxels of brain microvasculature including penetrating arterioles and capillary beds. A novel micro-emboli algorithm, informed by the experimental data, is used to simulate the impact of micro-emboli successively entering the penetrating arterioles and the capillary bed. Scaled-up blood flow parameters\u2013permeability and coupling coefficients\u2013are calculated under various conditions. We find that capillary beds are more susceptible to occlusions than the penetrating arterioles with a 4x greater drop in permeability per volume of vessel occluded. Individual microvascular geometries determine robustness to micro-emboli. Hard clot fragmentation leads to larger micro-emboli and larger drops in blood flow for a given number of micro-emboli. Thrombectomy technique has a large impact on clot fragmentation and hence occlusions in the microvasculature. As such, in-silico modelling of mechanical thrombectomy predicts that clot specific factors, interventional technique, and microvascular geometry strongly influence reperfusion of the brain. Micro-emboli are likely contributory to the phenomenon of no-reperfusion following successful removal of a major clot.<\/jats:p>","DOI":"10.1371\/journal.pcbi.1008515","type":"journal-article","created":{"date-parts":[[2021,3,12]],"date-time":"2021-03-12T13:37:14Z","timestamp":1615556234000},"page":"e1008515","update-policy":"https:\/\/doi.org\/10.1371\/journal.pcbi.corrections_policy","source":"Crossref","is-referenced-by-count":30,"title":["Modelling the impact of clot fragmentation on the microcirculation after thrombectomy"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2732-5927","authenticated-orcid":true,"given":"Wahbi K.","family":"El-Bouri","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3246-9826","authenticated-orcid":true,"given":"Andrew","family":"MacGowan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5082-0299","authenticated-orcid":true,"given":"Tam\u00e1s I.","family":"J\u00f3zsa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew J.","family":"Gounis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1156-2810","authenticated-orcid":true,"given":"Stephen J.","family":"Payne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,3,12]]},"reference":[{"key":"pcbi.1008515.ref001","author":"C Owens Johnson","year":"2019","journal-title":"Global, regional, and national burden of stroke, 1990\u20132016: a systematic analysis for the Global Burden of Disease Study 2016"},{"key":"pcbi.1008515.ref002","first-page":"263","volume-title":"Time is brain\u2014Quantified","author":"JL Saver","year":"2006"},{"key":"pcbi.1008515.ref003","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1001\/jamaneurol.2015.3886","article-title":"Time to Reperfusion and Treatment Effect for Acute Ischemic Stroke: A Randomized Clinical Trial","volume":"73","author":"PSS Fransen","year":"2016","journal-title":"JAMA Neurol. 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