{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:13:56Z","timestamp":1785212036482,"version":"3.55.0"},"reference-count":25,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,20]],"date-time":"2021-11-20T00:00:00Z","timestamp":1637366400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000266","name":"Engineering and Physical Sciences Research Council","doi-asserted-by":"publisher","award":["EP\/P020267\/1"],"award-info":[{"award-number":["EP\/P020267\/1"]}],"id":[{"id":"10.13039\/501100000266","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Combined intravenous thrombolysis and mechanical thrombectomy (IVT-MT) is a common treatment in acute ischaemic stroke, however the interaction between IVT and MT from a physiological standpoint is poorly understood. In this pilot study, we conduct numerical simulations of combined IVT-MT with various idealised stent retriever configurations to evaluate performance in terms of complete recanalisation times and lysis patterns. Methods: A 3D patient-specific geometry of a terminal internal carotid artery with anterior and middle cerebral arteries is reconstructed, and a thrombus is artificially implanted in the MCA branch. Various idealised stent retriever configurations are implemented by varying stent diameter and stent placement, and a configuration without a stent retriever provides a baseline for comparison. A previously validated multi-level model of thrombolysis is used, which incorporates blood flow, drug transport, and fibrinolytic reactions within a fibrin thrombus. Results: Fastest total recanalisation was achieved in the thrombus without a stent retriever, with lysis times increasing with stent retriever diameter. Two mechanisms of clot lysis were established: axial and radial permeation. Axial permeation from the clot front was the primary mechanism of lysis in all configurations, as it facilitated increased protein binding with fibrin fibres. Introducing a stent retriever channel allowed for radial permeation, which occurred at the fluid-thrombus interface, although lysis was much slower in the radial direction because of weaker secondary velocities. Conclusions: Numerical models can be used to better understand the complex physiological relationship between IVT and MT. Two different mechanisms of lysis were established, providing a basis towards improving the efficacy of combined treatments.<\/jats:p>","DOI":"10.3390\/life11111271","type":"journal-article","created":{"date-parts":[[2021,11,21]],"date-time":"2021-11-21T21:00:50Z","timestamp":1637528450000},"page":"1271","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Modelling Combined Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischaemic Stroke: Understanding the Relationship between Stent Retriever Configuration and Clot Lysis Mechanisms"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3594-3311","authenticated-orcid":false,"given":"Emily Louise","family":"Manchester","sequence":"first","affiliation":[{"name":"Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan","family":"Roi","sequence":"additional","affiliation":[{"name":"Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 8RF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boram","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK"},{"name":"School of Chemical Engineering, Chonnam National University, Gwangju 61186, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8267-621X","authenticated-orcid":false,"given":"Xiao Yun","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Chemical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyriakos","family":"Lobotesis","sequence":"additional","affiliation":[{"name":"Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 8RF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S0140-6736(13)61953-4","article-title":"Global and regional burden of stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010","volume":"383","author":"Feigin","year":"2014","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2450","DOI":"10.1161\/STROKEAHA.117.017320","article-title":"Mechanical thrombectomy outcomes with and without intravenous thrombolysis in stroke patients: A meta-analysis","volume":"48","author":"Mistry","year":"2017","journal-title":"Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1161\/STROKEAHA.120.031477","article-title":"Bridging thrombolysis achieved better outcomes than direct thrombectomy after large vessel occlusion: An updated meta-analysis","volume":"52","author":"Wang","year":"2021","journal-title":"Stroke"},{"key":"ref_4","unstructured":"Roos, Y. 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