The Impact of Thromboemboli Histology on the Performance of a Mechanical Thrombectomy Device

Yuki, Ichiro; Kan, Issei; Vinters, Harry V.; Kim, R H; Golshan, Alireza; Sayre, James W.; Murayama, Yuichi; Viñuela, Fernando

doi:10.3174/ajnr.a2842

Cited by 138 publications

(118 citation statements)

References 14 publications

Supporting

Mentioning

110

Contrasting

Unclassified

Order By: Relevance

“…13 Recently, several investigators reported the results of histologic studies analyzing the composition of the clots retrieved by mechanical thrombectomy in patients with acute ischemic stroke. 6,[14][15][16] These studies demonstrated that the presence of an SVS on GRE imaging was notably associated with a higher red blood cell content in the clots, whereas an absence of SVS was associated with fibrin-rich clots. Fibrin-dominant clots are usually formed because of injury to the endothelium overlying the complicated atheromatous plaque.…”

Section: Discussionmentioning

confidence: 87%

Negative Susceptibility Vessel Sign and Underlying Intracranial Atherosclerotic Stenosis in Acute Middle Cerebral Artery Occlusion

Kim¹,

Yoon²,

Heo³

et al. 2015

American Journal of Neuroradiology

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 87%

Negative Susceptibility Vessel Sign and Underlying Intracranial Atherosclerotic Stenosis in Acute Middle Cerebral Artery Occlusion

Kim¹,

Yoon²,

Heo³

et al. 2015

American Journal of Neuroradiology

View full text Add to dashboard Cite

show abstract

“…Recent in vitro data seem to suggest that fibrin‐rich thrombi containing relatively low amounts of erythrocytes are more resistant to thrombectomy, possibly because of their frictional properties 22, 23…”

Section: Discussionmentioning

confidence: 99%

High‐Resolution Imaging of Interaction Between Thrombus and Stent‐Retriever in Patients With Acute Ischemic Stroke

Autar

Hund

Ramlal

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundCurrently, acute ischemic stroke is still a leading cause of mortality and morbidity. Approximately 2 years ago, mechanical thrombectomy was proven beneficial as a revolutionary new therapy for stroke in the MR‐CLEAN trial (A Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). However, the mechanisms by which the thrombectomy device, or stent‐retriever, interacts with the thrombus are largely unknown. A better understanding could lead to improved efficacy of mechanical thrombectomy devices.Methods and ResultsSeven stent‐retrievers with thrombi still entrapped were collected directly after thrombectomy. The stent‐retrievers were studied using micro computed tomography, followed by scanning electron microscopy and light microscopy. Two independent observers rated interaction type and thrombus surface structure (porous filamentous or dense) at the interaction sites.A total of 79 interaction sites between thrombus and stent‐retriever were categorized. Thrombus‐stent‐retriever interaction was found to be adhesive (n=44; 56%) or mechanical (n=35; 44%). Adhesive interaction was most frequently observed at interaction sites with a dense surface, compared with interaction sites with a porous filamentous fibrin surface (38/58; 66% versus 6/21; 29%, P=0.011).ConclusionsThe interaction between thrombus and stent‐retriever was predominantly adhesive, not mechanical. Adhesive interaction was strongly associated with the presence of a dense thrombus surface without a porous filamentous fibrin network.

show abstract

“…Other areas of interest would include analysis of the retrieved and injected clot, including variations of the clot production, such as the use of fibrin-rich clot. 19 Analysis of distal clot propagation and time to recanalization of bifurcation occlusions may also be of interest in future studies.…”

Section: Future Experimentsmentioning

confidence: 99%

Development of a recalcitrant, large clot burden, bifurcation occlusion model for mechanical thrombectomy

Srinivasan¹,

Chen

Camstra³

et al. 2017

FOC

View full text Add to dashboard Cite

OBJECTIVE Stroke is a major cause of disability and death in adults. Several large randomized clinical trials have shown the significant benefit of mechanical thrombectomy with modern stent retrievers in the treatment of large-vessel occlusions. However, large clots located at bifurcations remain challenging to treat. An in vivo model of these recalcitrant clots needs to be developed to test future generations of devices. METHODS Autologous blood was drawn from anesthetized swine via a femoral sheath. Blood was then mixed with thrombin, calcium chloride, and saline, and injected into silicone tubing to form cylindrical clots in the standard fashion. Matured clots were then delivered in an unfragmented fashion directly into the distal extracranial vasculature, at branch points where vessel sizes mimic the human middle cerebral artery, by using Penumbra aspiration tubing and the Penumbra ACE68 reperfusion catheter. RESULTS A total of 5 adult swine were used to develop the model. The techniques evolved during experiments in the first 3 animals, and the last 2 were used to establish the final model. In these 2 swine, a total of 8 autologous clots, 15–20 mm, were injected directly into 8 distal extracranial vessels at branch points to mimic a bifurcation occlusion in a human. All clots were delivered directly at a distal bifurcation or trifurcation in an unfragmented fashion to cause an occlusion. Ten revascularization attempts were made, and none of the branch-point occlusions were fully revascularized on the first attempt. CONCLUSIONS Using novel large-bore distal access catheters, large unfragmented clots can be delivered into distal extracranial vessels in a swine occlusion model. The model mimics the clinical situation of a recalcitrant bifurcation occlusion and will be valuable in the study of next-generation stroke devices and in training settings.

show abstract

The Impact of Thromboemboli Histology on the Performance of a Mechanical Thrombectomy Device

Cited by 138 publications

References 14 publications

Negative Susceptibility Vessel Sign and Underlying Intracranial Atherosclerotic Stenosis in Acute Middle Cerebral Artery Occlusion

Negative Susceptibility Vessel Sign and Underlying Intracranial Atherosclerotic Stenosis in Acute Middle Cerebral Artery Occlusion

High‐Resolution Imaging of Interaction Between Thrombus and Stent‐Retriever in Patients With Acute Ischemic Stroke

Development of a recalcitrant, large clot burden, bifurcation occlusion model for mechanical thrombectomy

Contact Info

Product

Resources

About