Association between clot composition and stroke origin in mechanical thrombectomy patients: analysis of the Stroke Thromboembolism Registry of Imaging and Pathology

Brinjikji, Waleed; Nogueira, Raul G; Kvamme, Peter; Layton, Kennith F.; Almandoz, Josser E Delgado; Hanel, Ricardó A.; Pereira, Vítor Mendes; Almekhlafi, Mohammed; Yoo, Albert J.; Jahromi, Babak S.; Gounis, Matthew J.; Patel, Biraj M.; Abbasi, Mehdi; Fitzgerald, Seán; Mereuta, Oana Madalina; Dai, Daying; Kadirvel, Ramanathan; Doyle, Karen M.; Savastano, Luis; Cloft, Harry J.; Haussen, Diogo C; Al‐Bayati, Alhamza R; Mohammaden, Mahmoud; Pisani, Leonardo; Rodrigues, Gabriel M; Thacker, Ike; Kayan, Yasha; Copelan, Alexander; Aghaebrahim, Amin; Sauvageau, Eric; Demchuk, Andrew M.; Bhuva, Parita; Soomro, Jazba; Nazari, Pouya; Cantrell, Donald R.; Puri, Ajit S; Entwistle, John J.; Polley, Eric C.; Kallmes, David F.

doi:10.1136/neurintsurg-2020-017167

Cited by 60 publications

(43 citation statements)

References 17 publications

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“…The understanding of clot formation has improved in recent years with reports of analyses of retrieved clots. Clot composition may be predictive of stroke etiology, but this is debated in the literature, with controversial findings among the studies ( 33 , 49 – 51 ). The composition of the clot could also affect the outcome of thrombolysis or mechanical thrombectomy ( 52 ).…”

Section: Discussionmentioning

confidence: 99%

Factors That Influence Susceptibility Vessel Sign in Patients With Acute Stroke Referred for Mechanical Thrombectomy

et al. 2022

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Background and PurposeThe presence of a Susceptibility Vessel Sign (SVS) in the acute phase of proximal occlusion ischemic stroke indicates the presence of deoxyhemoglobin in the thrombus. Thrombi composition changes over time. The aim of this study was to investigate whether the absence of SVS is associated with a shorter symptom onset to imaging time.MethodsWe retrospectively analyzed all patients referred for mechanical thrombectomy at Besançon University Hospital between 1 January 2015 and 31 December 2020 for whom readable T2*-weighted imaging was available. We compared patient characteristics according to the presence or absence of an SVS. We also studied the subgroup for whom the exact symptom onset time was known. We performed a univariate statistical analysis, then a multivariate analysis on the variables that were statistically significant in the univariate analysis.ResultsOf the 389 patients included, 309 (79.4%) were SVS+. We found no significant relationship between SVS– and the time between symptom onset and imaging in the whole cohort. In the multivariate analysis, SVS– was associated with anticoagulant treatment (p < 0.01), and SVS+ with age (p = 0.023) and carotid terminus occlusion (p = 0.042). In the known symptom onset subgroup, SVS– was significantly associated with a shorter symptom onset -imaging time (p < 0.001), and this was confirmed in the multivariate analysis (p = 0.011; OR 0.911; 95% CI [0.844; 0.972]).ConclusionIn the acute phase of proximal occlusion ischemic stroke, absence of SVS was associated with a shorter symptom onset–imaging time for patients with a known symptom onset time.

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Section: Discussionmentioning

confidence: 99%

Factors That Influence Susceptibility Vessel Sign in Patients With Acute Stroke Referred for Mechanical Thrombectomy

et al. 2022

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“…Within the thrombus analogs, RBCs ranged from 4–53%, fibrin ranged from 10–60%, platelets ranged from 10–67%, and WBCs ranged from 1–6%. The ranges of histopathologic compositions of the thrombus analogs were similar to thrombi retrieved from stroke patients with LVO stroke 23. Thrombus analogs were heterogeneous in structure.…”

Section: Resultsmentioning

confidence: 72%

An in vitro model for Extracellular DNA Traps (ETs)-rich Human Thrombus Analogs

Liu

Dai

Abbasi

et al. 2022

J NeuroIntervent Surg

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BackgroundExtracellular DNA traps (ETs) have important implications in both thrombosis and thrombolysis. Thus, developing benchtop thrombus analogs that recapitulate clinical ETs is potentially of great value for preclinical development and testing of thrombolytic agents and thrombectomy devices. In this study, we aimed to develop ETs-rich thrombus analogs for preclinical testing.MethodsRed blood cell (RBC)-rich, fibrin-rich, and platelet-rich thrombus analogs were created using human whole blood, platelet-poor plasma, and platelet-rich plasma obtained from the blood bank following institutional approval. Peripheral blood mononuclear cells (9.9×106 cells/mL) isolated from human whole blood and lipopolysaccharide (1 µg/mL) were added to induce ETs. Histochemical, immunohistochemistry and immunofluorescence were used to identify thrombus components and ETs. Scanning electronic microscopy was used to investigate the ultrastructure of the thrombus analogs. The thrombus compositions, morphologic features of ETs and citrullinated histone H3 (H3Cit) expression were compared with those of thrombi retrieved from patients by thrombectomy.ResultsETs-rich thrombus analogs were more compacted th-an the ETs-poor thrombus analogs. ETs were identified in both ETs-rich thrombus analogs and patient thrombi showing morphologic features including nuclear lobulation, nuclear swelling, diffused chromatin within cytoplasm, DNA/chromatin extending intracellularly and extracellularly, and extracellular chromatin patches and bundles. In the ETs-poor thrombus analogs, ETs were not observed and H3Cit expression was absent to minimal. The compositions and H3Cit expression in the ETs-rich thrombus analogs fell in the range of patient thrombi.ConclusionsETs-rich thrombus analogs can be consistently created in vitro and may benefit the preclinical development and testing of new thrombolytic agents and thrombectomy devices.

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“…Linking clot composition and preoperative imaging clot features [57] may help select optimal individual treatment strategies. Clot analysis may also help in assessing the underlying cause of stroke [58] and thereby aiding secondary prevention.…”

Section: Endovascular Treatment For Strokementioning

confidence: 99%

Endovascular thrombectomy for acute ischemic stroke

et al. 2022

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This review describes the evolution of endovascular treatment for acute ischemic stroke, current state of the art, and the challenges for the next decade. The rapid development of endovascular thrombectomy (EVT), from the first attempts into standard of care on a global scale, is one of the major achievements in modern medicine. It was possible thanks to the establishment of a scientific framework for patient selection, assessment of stroke severity and outcome, technical development by dedicated physicians and the MedTech industry, including noninvasive imaging for patient selection, and radiological outcome evaluation. A series of randomized controlled trials on EVT in addition to intravenous thrombolytics, with overwhelmingly positive results for anterior circulation stroke within 6 h of onset regardless of patient characteristics with a number needed to treat of less than 3 for any positive shift in outcome, paved the way for a rapid introduction of EVT into clinical practice. Within the “extended” time window of 6–24 h, the effect has been even greater for patients with salvageable brain tissue according to perfusion imaging with a number needed to treat below 2. Even so, EVT is only available for a small portion of stroke patients, and successfully recanalized EVT patients do not always achieve excellent functional outcome. The major challenges in the years to come include rapid prehospital detection of stroke symptoms, adequate clinical and radiological diagnosis of severe ischemic stroke cases, enabling effective recanalization by EVT in dedicated angiosuites, followed by personalized post‐EVT stroke care.

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Association between clot composition and stroke origin in mechanical thrombectomy patients: analysis of the Stroke Thromboembolism Registry of Imaging and Pathology

Cited by 60 publications

References 17 publications

Factors That Influence Susceptibility Vessel Sign in Patients With Acute Stroke Referred for Mechanical Thrombectomy

Factors That Influence Susceptibility Vessel Sign in Patients With Acute Stroke Referred for Mechanical Thrombectomy

An in vitro model for Extracellular DNA Traps (ETs)-rich Human Thrombus Analogs

Endovascular thrombectomy for acute ischemic stroke

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