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Exploring the relationship between embolic acute stroke distribution and supra-aortic vessel patency: key findings from an in vitro model study

Aglae Velasco Gonzalez, Cristina Sauerland, Dennis Görlich, Joaquin Ortega-Quintanilla, Astrid Jeibmann, Andreas Faldum, Werner Paulus, Walter Heindel, Boris Buerke
DOI: 10.1136/svn-2023-003024 Published 25 February 2025
Aglae Velasco Gonzalez
1 Clinic for Radiology, Neuroradiology, University of Münster and University Hospital of Münster, Münster, Germany
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  • ORCID record for Aglae Velasco Gonzalez
Cristina Sauerland
2 Institute of Biostatistics and Clinical Research, University of Münster, Munster, Germany
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Dennis Görlich
2 Institute of Biostatistics and Clinical Research, University of Münster, Munster, Germany
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Joaquin Ortega-Quintanilla
3 Interventional Neuroradiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Astrid Jeibmann
4 Institute of Neuropathology, University of Münster, Munster, Germany
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Andreas Faldum
2 Institute of Biostatistics and Clinical Research, University of Münster, Munster, Germany
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Werner Paulus
4 Institute of Neuropathology, University of Münster, Munster, Germany
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Walter Heindel
1 Clinic for Radiology, Neuroradiology, University of Münster and University Hospital of Münster, Münster, Germany
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Boris Buerke
1 Clinic for Radiology, Neuroradiology, University of Münster and University Hospital of Münster, Münster, Germany
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  • Figure 1
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    Figure 1

    Sequential lodges by the 406 total emboli for the four anatomical conditions of the supra-aortic vessels tested. After fragmentation, the median number of lodgments per clot was four, with a minimum of 1 and a maximum of 8. The number indicated over each graphic (ranging from 1 to 8) is the sequential number of lodgments referred to in that chart. See the online supplemental table S1 for a more detailed description. ACA, anterior cerebral artery; ICA, internal carotid artery; MCA, middle cerebral artery; PCA, posterior cerebral artery.

  • Figure 2
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    Figure 2

    Sankey flow diagrams of sequential embolic lodgments by anatomical condition of the supra-aortic vessels. The diagram shows the flows and their relative quantities in proportion to each other. Vertical coloured lines represent each lodgment (first, second, third, etc). Horizontal flow lines represent the relative quantity of fragments anchored at a particular intracranial location after a specific prior clot allocation. Emboli that migrated to the opposite hemisphere are shown in blue. Emboli that travelled to the ipsilateral ACA are shown in green. (A) Baseline: supra-aortic vessels without occlusion (97 emboli from 29 injected clots); (B) Emboli from an occluded right CA (88/25); (C) Emboli through the right CA with occlusion of the left CA (122/24); (D) Emboli through the right CA with concomitant occlusion of both vertebral arteries (99/26). ACA, anterior cerebral artery; CA, carotid artery; ICA-T, terminal internal CA; MCA, middle cerebral artery; PCA, posterior cerebral artery.

Tables

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  • Table 1

    Frequency of intracranial lodgment of clot fragments for the four SAV conditions tested

    Embolus locationTotal emboli*
    (n=406)
    Patent
    SAV
    (n=97)
    Ipsilateral CA occluded
    (n=88)
    Contralateral CA occluded
    (n=122)
    Vertebral arteries occluded
    (n=99)
    P value
    Ipsilateral MCA159
    (39.2%)
    47
    (48.5%)
    33
    (37.5%)
    39
    (32%)
    40
    (40.4%)
    <0.0001
    Ipsilateral A1 and A2 segments99
    (24.4%)
    28
    (28.9%)
    14
    (15.9%)
    30
    (24.6%)
    27
    (27.3%)
    Ipsilateral PCA56
    (13.8%)
    11
    (11.3%)
    12
    (13.6%)
    8
    (6.6%)
    25
    (25.3%)
    Contralateral MCA33
    (8.1%)
    0
    –
    7
    (8%)
    25
    (20.5%)
    1
    (1%)
    Contralateral A1 and A2 segments+ACoA30
    (7.4%)
    1
    (1%)
    5
    (5.7%)
    20
    (16.4%)
    4
    (4%)
    Floating ICA thrombus16
    (3.9%)
    6
    (6.2%)
    10
    (11.4%)
    0
    –
    0
    –
    Terminal ICA11
    (2.7%)
    4
    (4.1%)
    5
    (5.7%)
    0
    –
    2
    (2%)
    Contralateral PCA2
    (0.5%)
    0
    –
    2
    (2.3%)
    0
    –
    0
    –
    • Markov Chain Monte Carlo estimated p value.

    • *Fragments of the same clot repeating an anchor location have also been included.

    • ACoA, anterior communicating artery; CA, carotid artery; MCA, middle cerebral artery; PCA, posterior cerebral artery; SAV, supra-aortic vessel.

Supplementary Materials

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    [svn-2023-003024supp001.pdf]

Additional Files

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  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    • Data supplement 1
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Exploring the relationship between embolic acute stroke distribution and supra-aortic vessel patency: key findings from an in vitro model study
Aglae Velasco Gonzalez, Cristina Sauerland, Dennis Görlich, Joaquin Ortega-Quintanilla, Astrid Jeibmann, Andreas Faldum, Werner Paulus, Walter Heindel, Boris Buerke
Stroke and Vascular Neurology Feb 2025, 10 (1) 78-85; DOI: 10.1136/svn-2023-003024

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Exploring the relationship between embolic acute stroke distribution and supra-aortic vessel patency: key findings from an in vitro model study
Aglae Velasco Gonzalez, Cristina Sauerland, Dennis Görlich, Joaquin Ortega-Quintanilla, Astrid Jeibmann, Andreas Faldum, Werner Paulus, Walter Heindel, Boris Buerke
Stroke and Vascular Neurology Feb 2025, 10 (1) 78-85; DOI: 10.1136/svn-2023-003024
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Exploring the relationship between embolic acute stroke distribution and supra-aortic vessel patency: key findings from an in vitro model study
Aglae Velasco Gonzalez, Cristina Sauerland, Dennis Görlich, Joaquin Ortega-Quintanilla, Astrid Jeibmann, Andreas Faldum, Werner Paulus, Walter Heindel, Boris Buerke
Stroke and Vascular Neurology Feb 2025, 10 (1) 78-85; DOI: 10.1136/svn-2023-003024
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