Flow-induced permeation of non-occlusive blood clots: an MRI study and modelling

Mathematical modeling of blood clot fragmentation during flow-mediated thrombolysis

A microscale mathematical model of blood clot dissolution based on coarse-grained molecular dynamics is presented. In the model, a blood clot is assumed to be an assembly of blood cells interconnected with elastic fibrin bonds, which are cleaved either biochemically (bond degradation) or mechanically (bond overstretching) during flow-mediated thrombolysis. The effect of a thrombolytic agent on biochemical bond degradation was modeled phenomenologically by assuming that the decay rate of an individual bond is a function of the remaining noncleaved bonds in the vicinity of that bond (spatial corrosion) and the relative stretching of the bond (deformational corrosion). The results of simulations indicate that the blood clot dissolution process progresses by a blood-flow-promoted removal of clot fragments, the sizes of which are flow-dependent. These findings are in good agreement with the results of our recent optical-microscopy experimental studies on a model of blood clot dissolution, as well as with clinical observations. The findings of this study may contribute to a better understanding of the clot fragmentation process and may therefore also help in designing new, safer thrombolytic approaches.

Microscopic clot fragment evidence of biochemo-mechanical degradation effects in thrombolysis

INTRODUCTION

Although fibrinolytic treatment has been used for decades, the interactions between the biochemical mechanisms and the mechanical forces of the streaming blood remain incompletely understood. Analysis of the blood clot surface in vitro was employed to study the concomitant effect of blood plasma flow and recombinant tissue plasminogen activator (rt-PA) on the degradation of retracted, non-occlusive blood clots. Our hypothesis was that a faster tangential plasma flow removed larger fragments and resulted in faster overall thrombolysis.

MATERIALS AND METHODS

Retracted model blood clots were prepared in an optical microscopy chamber and connected to an artificial perfusion system with either no-flow, or plasma flow with a velocity of 3 cm/s or 30 cm/s with or without added rt-PA at 2 microg/ml. The clot surface was dynamically imaged by an optical microscope for 30 min with 15s intervals.

RESULTS

The clot fragments removed during rt-PA mediated thrombolysis ranged in size from that of a single red blood cell to large agglomerates composed of more than a thousand red blood cells bound together by partly degraded fibrin. The average and the largest discrete clot area change between images in adjacent time frames were significantly higher with the faster flow than with the slow flow (14,000 microm(2) and 160,000 microm(2) vs. 2200 microm(2) and 10,600 microm(2)).

CONCLUSIONS

On the micrometer scale, thrombolysis consists of sequential removal of clot fragments from the clot surface. With increasing tangential plasma flow velocity, the size of the clot fragments and the overall rate of thrombolysis increases.