Spatial heterogeneity of occlusive thrombus in acute ischemic stroke: A systematic review

LaGrange, Daniela Dumitriu; Reymond, Philippe; Brina, Olivier; Zboray, Robert; Neels, Antonia; Wanke, Isabel; Lövblad, Karl‐Olof

doi:10.1016/j.neurad.2023.01.004

Cited by 4 publications

(2 citation statements)

References 58 publications

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“…Therefore, additional investigations are required to discern the patient groups for which heterogeneity can be a valuable biomarker. Furthermore, in this study we used a basic and intuitive definition for heterogeneity, while more complex formulations may be more descriptive of this biomarker [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Value of Automatically Derived Full Thrombus Characteristics: An Explorative Study of Their Associations with Outcomes in Ischemic Stroke Patients

Mojtahedi,

Bruggeman,

van Voorst

et al. 2024

JCM

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(1) Background: For acute ischemic strokes caused by large vessel occlusion, manually assessed thrombus volume and perviousness have been associated with treatment outcomes. However, the manual assessment of these characteristics is time-consuming and subject to inter-observer bias. Alternatively, a recently introduced fully automated deep learning-based algorithm can be used to consistently estimate full thrombus characteristics. Here, we exploratively assess the value of these novel biomarkers in terms of their association with stroke outcomes. (2) Methods: We studied two applications of automated full thrombus characterization as follows: one in a randomized trial, MR CLEAN-NO IV (n = 314), and another in a Dutch nationwide registry, MR CLEAN Registry (n = 1839). We used an automatic pipeline to determine the thrombus volume, perviousness, density, and heterogeneity. We assessed their relationship with the functional outcome defined as the modified Rankin Scale (mRS) at 90 days and two technical success measures as follows: successful final reperfusion, which is defined as an eTICI score of 2b-3, and successful first-pass reperfusion (FPS). (3) Results: Higher perviousness was significantly related to a better mRS in both MR CLEAN-NO IV and the MR CLEAN Registry. A lower thrombus volume and lower heterogeneity were only significantly related to better mRS scores in the MR CLEAN Registry. Only lower thrombus heterogeneity was significantly related to technical success; it was significantly related to a higher chance of FPS in the MR CLEAN-NO IV trial (OR = 0.55, 95% CI: 0.31–0.98) and successful reperfusion in the MR CLEAN Registry (OR = 0.88, 95% CI: 0.78–0.99). (4) Conclusion: Thrombus characteristics derived from automatic entire thrombus segmentations are significantly related to stroke outcomes.

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Section: Discussionmentioning

confidence: 99%

Value of Automatically Derived Full Thrombus Characteristics: An Explorative Study of Their Associations with Outcomes in Ischemic Stroke Patients

Mojtahedi,

Bruggeman,

van Voorst

et al. 2024

JCM

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“…Heterogeneous thrombi. Thrombi in ischemic strokes are not homogeneous [48][49][50][51] . We take advantage of the high adaptability of the numerical mesoscopic model to explore the flow-driven lysis of heterogeneous thrombi.…”

Section: Mesoscopic Model Of Fibrinolysismentioning

confidence: 99%

A simplified mesoscale 3D model for characterizing fibrinolysis under flow conditions

Petkantchin

Rousseau

Boudjeltia

et al. 2023

Preprint

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One of the routine clinical treatments to eliminate ischemic stroke thrombi is injecting a biochemical product into the patient’s bloodstream, which breaks down the thrombi’s fibrin fibers: intravenous or intravascular thrombolysis. Unfortunately, however, the successful outcome of this procedure is still more of an exception than the rule. Understanding why from clinical evidence is close to impossible, given that no existing tool can track the lysis at the thrombus scale and that time is limited due to the emergency. For that reason, we conductedin vitroflow-driven fibrinolysis experiments to study pure fibrin thrombi breakdown in controlled conditions and observed that the lysis front evolved non-linearly in time. To understand these results, we developed an analytical 1D lysis model in which the thrombus is considered a porous medium. The lytic cascade is reduced to a second-order reaction involving fibrin and a surrogate pro-fibrinolytic agent. The model was able to reproduce the observed lysis evolution under the assumptions of constant fluid velocity and lysis occurring only at the front. For adding complexity, such as clot heterogeneity or complex flow conditions, we propose a 3-dimensional mesoscopic numerical model of blood flow and fibrinolysis, which validates the analytical model’s results. Such a numerical model could help us better understand the spatial evolution of the thrombi breakdown, extract the most relevant physiological parameters to lysis efficiency, and possibly explain the failure of the clinical treatment. These findings suggest that even though real-world fibrinolysis is a complex biological process, a simplified model can recover the main features of lysis evolution.

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MRI characterization of in vitro clots at 3T and 7T: A technical note

LaGrange

Xin

Lazeyras

et al. 2024

Journal of Neuroradiology

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Spatial heterogeneity of occlusive thrombus in acute ischemic stroke: A systematic review

Cited by 4 publications

References 58 publications

Value of Automatically Derived Full Thrombus Characteristics: An Explorative Study of Their Associations with Outcomes in Ischemic Stroke Patients

Value of Automatically Derived Full Thrombus Characteristics: An Explorative Study of Their Associations with Outcomes in Ischemic Stroke Patients

A simplified mesoscale 3D model for characterizing fibrinolysis under flow conditions

MRI characterization of in vitro clots at 3T and 7T: A technical note

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