The Neuro Thromboembolic Initiative: Addressing the science behind clots.

Patrick Brouwer, in the center of 5 colleagues in front of a CERENOVUS NTI branded background

CERENOVUS continues to push the boundaries of what’s possible in stroke care. By using innovative, cutting-edge techniques and investing in high-quality research, we aim to deliver on our promise to change the trajectory of stroke. 

For World Stroke Day 2022, we sat down with Patrick Brouwer, MD, Neurointerventionalist, Head of Worldwide Medical Affairs, to discuss CERENOVUS’ exciting Neuro Thromboembolic Initiative (NTI) – what it is, its benefits to the scientific community, and his experience working as a physician and as part of the CERNOVUS team. 

Starting off, what is the Neuro Thromboembolic Initiative (NTI)?  

The Neuro Thromboembolic Initiative (NTI) can be considered as a commitment by CERENOVUS to advance the treatment of stroke through interdisciplinary collaboration and investment in clot and occlusion research.  

What are the objectives of NTI?  

In short, NTI is all about science. The scientists working on this team are studying the fundamentals of stroke in order to have a clear understanding of the clinical problem. By researching the science of stroke, we can better design strategies to overcome the clinical problem.  

Can you explain more about how and why NTI creates real-world scenarios? 

NTI aims to replicate different types of clots, as well as real-life treatment scenarios. This is done by creating models that are based on challenging situations, encountered during actual patient treatments. The models, based on real patient anatomy, are then used to replicate or simulate the procedures and come up with solutions for clinical problems that we might be confronted with in a patient.  

Why does CERENOVUS place so much emphasis on studying clots? 

There are several reasons. First and foremost, to get the best possible device interaction with the clot that we want to get out. If you can study that and understand it, you can tailor your device to match the clot you want to remove. 

Before NTI started researching clots and stroke science, there was limited understanding of blood vessel occlusions. You can imagine that for a clinical physician, it was like a black box – you see a patient and then you go in and use your device to try and remove the clot. However, you may suddenly notice it won't come out. Well, why doesn't it come out?  

Through NTI, we started to understand that there’s a large range of clots, each with different components that have different attributes that affect how easy it is to get the clot out. We also gained a better understanding of the kind of interaction the clot has with the vessel wall for example, or even the device that we used to remove it. That's where this research really makes a difference because previously, we didn't know what a clot was, except for some “red (sometimes white) stuff” that you removed out of the patient. 

NTI also publishes their findings, so everything that we study goes into scientific literature that is available to the wider scientific community to help expand understanding of the field.


Can you provide an example of how research by NTI has influenced device development? 

We noticed that there was a subgroup of clots that were difficult to get out – we call them “tough clots.” These are clots that have a different fibrin and platelet content compared to the normal clots. We studied how these tough clots behave, what the friction was like, what influence compression on the clot had on the structure and ease of removal, and many other features.  

The technique for removing this subgroup of clots is totally different. You must engage the clot and really pinch part of it into a loop or a lasso which allows you to pull it out rather than catch it. That's something that we found out during bench-top testing. Off the back of this we developed a tailored device, specifically designed to address those tough fibrin richer clots. 

Can you tell us a little bit about your experience of working with the CERENOVUS team as a physician before you joined the company? 

I first started working with CERENOVUS engineers to test their new device in a clinical setting. I built up experience with the device and, after moving to Karolinska University in Stockholm in 2014, where the device was also used, our whole team gained lots of experience and became experts. We hosted a lot of teaching sessions on its use. 

CERENOVUS then approached me, and a few others, and asked if we wanted to participate in the basic research, and the testing on early models. Our team published a lot on the evidence we gathered during these clinical and bench-top studies. 

Beyond publishing the research, how does CERENOVUS share its knowledge and expertise with the neurovascular community? 

We run courses with heads of departments and senior physicians with a lot of experience to help translate the work we do into clinical application. We also run well-attended courses for medical specialists in training, as well as sessions for discussion between those with a lot of experience. I personally think that our best way of executing evidence dissemination is through our technical and field engineers – sending them out into the world to share their expertise in the hospital with a team of physicians, nurses and all support personnel. Afterall, these field engineers are the experts: they have PhDs in clot research, they know about the models and all details of the NTI research performed and published. 

Last question, what makes NTI unique? 

This kind of scientific institute cannot be found in any other company; they are normally only part of a university department. They work together with numerous universities and hospital departments as well as scientific labs with interests that are similar. Other than that, beyond bench-top testing, NTI delves deeper into science and research to support device development and informs the field of the learnings.  

The people working in NTI are highly trained in sciences and biotechnology rather than purely device engineering.  At CERENOVUS the role of engineers is not only to make the devices, but to also know, provide, and further the science and research. That combination is the starting point for device development and has proven its benefit!