title: Clot friction variation with fibrin content; implications for resistance to thrombectomy.
abstract: BACKGROUND
  Despite significant advancements in the procedural efficacy of mechanical thrombectomy in patients with ischemic stroke in recent years, there still remains a portion of the population that does not achieve good recanalization. The reasons for this may be varied. We hypothesized that static friction between the clot and the vessel, or catheter wall might contribute to the difficulty in removing the clot.
  
  
  OBJECTIVE
  To determine if there is a relationship between clot composition and the resistance to sliding (friction) which might contribute to resistance to clot removal.
  
  
  METHODS
  As clot composition can vary significantly, we investigated five different types of clot in order to measure their respective frictional properties. To do this, a custom-made testing apparatus was created, consisting of various replaceable low-friction surfaces on which the clots could be placed. The surface was then gradually tilted until the clots began to slide; the angle at which this occurred is related to the coefficient of friction of the clots. The experiment was repeated on a bovine aortic surface in order to confirm the results.
  
  
  RESULTS
  We found that fibrin-rich clots (<20% red blood cell content) have a significantly higher coefficient of friction than clots with a red blood cell content >20%. This result was confirmed by repeating the experiment on a bovine aortic surface as a representation of the interaction between clots and the arterial wall.
  
  
  CONCLUSIONS
  The friction properties of clots were found to be related to the content ratio of fibrin to red blood cells. Future imaging techniques that could show fibrin and red blood cell content might help us to predict the 'stickiness' of a clot.
authors.affiliation: Neuravi Ltd, Galway, Ireland.
authors.forename: Gillian M
authors.identifier: http://orcid.org/0000-0002-5368-9898
authors.initials: GM
authors.lastname: Gunning
authors.affiliation: Neuravi Ltd, Galway, Ireland.
authors.forename: Kevin
authors.initials: K
authors.lastname: McArdle
authors.affiliation: Neuravi Ltd, Galway, Ireland.
authors.forename: Mahmood
authors.initials: M
authors.lastname: Mirza
authors.affiliation: Neuravi Ltd, Galway, Ireland.|Department of Mechanical and Industrial Engineering, Galway-Mayo Technologies Centre, Galway-Mayo Institute of Technology, Galway, Ireland.
authors.forename: Sharon
authors.initials: S
authors.lastname: Duffy
authors.affiliation: Neuravi Ltd, Galway, Ireland.
authors.forename: Michael
authors.initials: M
authors.lastname: Gilvarry
authors.affiliation: Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Brouwer
mesh_terms: D000818:Animals; D001777:Blood Coagulation / Q000502:physiology*; D004912:Erythrocytes / Q000502:physiology*; D005337:Fibrin / Q000032:analysis* / Q000502:physiology*; D017276:Friction / Q000502:physiology*; D012756:Sheep; D017131:Thrombectomy / Q000379:methods*; D013927:Thrombosis / Q000503:physiopathology
chemical_list: D005337:Fibrin
keywords: Stroke; Thrombectomy