TY - JOUR
T1 - Clot composition and recanalization outcomes in mechanical thrombectomy
AU - Nogueira, Raul G.
AU - Pinheiro, Agostinho
AU - Brinjikji, Waleed
AU - Abbasi, Mehdi
AU - Al-Bayati, Alhamza R.
AU - Mohammaden, Mahmoud H.
AU - Souza Viana, Lorena
AU - Ferreira, Felipe
AU - Abdelhamid, Hend
AU - Bhatt, Nirav R.
AU - Kvamme, Peter
AU - Layton, Kennith F.
AU - Delgado Almandoz, Josser E.
AU - Hanel, Ricardo A.
AU - Mendes Pereira, Vitor
AU - Almekhlafi, Mohammed A.
AU - Yoo, Albert J.
AU - Jahromi, Babak S.
AU - Gounis, Matthew J.
AU - Patel, Biraj
AU - Arturo Larco, Jorge L.
AU - Fitzgerald, Sean
AU - Mereuta, Oana Madalina
AU - Doyle, Karen
AU - Savastano, Luis E.
AU - Cloft, Harry J.
AU - Thacker, Ike C.
AU - Kayan, Yasha
AU - Copelan, Alexander
AU - Aghaebrahim, Amin
AU - Sauvageau, Eric
AU - Demchuk, Andrew M.
AU - Bhuva, Parita
AU - Soomro, Jazba
AU - Nazari, Pouya
AU - Cantrell, Donald Robert
AU - Puri, Ajit S.
AU - Entwistle, John
AU - Polley, Eric C.
AU - Frankel, Michael R.
AU - Kallmes, David F.
AU - Haussen, Diogo C.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2024/5/1
Y1 - 2024/5/1
N2 - Background Mechanical thrombectomy (MT) has become standard for large vessel occlusions, but rates of complete recanalization are suboptimal. Previous reports correlated radiographic signs with clot composition and a better response to specific techniques. Therefore, understanding clot composition may allow improved outcomes. Methods Clinical, imaging, and clot data from patients enrolled in the STRIP Registry from September 2016 to September 2020 were analyzed. Samples were fixed in 10% phosphate-buffered formalin and stained with hematoxylin-eosin and Martius Scarlett Blue. Percent composition, richness, and gross appearance were evaluated. Outcome measures included the rate of first-pass effect (FPE, modified Thrombolysis in Cerebral Infarction 2c/3) and the number of passes. Results A total of 1430 patients of mean±SD age 68.4±13.5 years (median (IQR) baseline National Institutes of Health Stroke Scale score 17.2 (10.5-23), IV-tPA use 36%, stent-retrievers (SR) 27%, contact aspiration (CA) 27%, combined SR+CA 43%) were included. The median (IQR) number of passes was 1 (1-2). FPE was achieved in 39.3% of the cases. There was no association between percent histological composition or clot richness and FPE in the overall population. However, the combined technique resulted in lower FPE rates for red blood cell (RBC)-rich (P<0.0001), platelet-rich (P=0.003), and mixed (P<0.0001) clots. Fibrin-rich and platelet-rich clots required a higher number of passes than RBC-rich and mixed clots (median 2 and 1.5 vs 1, respectively; P=0.02). CA showed a trend towards a higher number of passes with fibrin-rich clots (2 vs 1; P=0.12). By gross appearance, mixed/heterogeneous clots had lower FPE rates than red and white clots. Conclusions Despite the lack of correlation between clot histology and FPE, our study adds to the growing evidence supporting the notion that clot composition influences recanalization treatment strategy outcomes.
AB - Background Mechanical thrombectomy (MT) has become standard for large vessel occlusions, but rates of complete recanalization are suboptimal. Previous reports correlated radiographic signs with clot composition and a better response to specific techniques. Therefore, understanding clot composition may allow improved outcomes. Methods Clinical, imaging, and clot data from patients enrolled in the STRIP Registry from September 2016 to September 2020 were analyzed. Samples were fixed in 10% phosphate-buffered formalin and stained with hematoxylin-eosin and Martius Scarlett Blue. Percent composition, richness, and gross appearance were evaluated. Outcome measures included the rate of first-pass effect (FPE, modified Thrombolysis in Cerebral Infarction 2c/3) and the number of passes. Results A total of 1430 patients of mean±SD age 68.4±13.5 years (median (IQR) baseline National Institutes of Health Stroke Scale score 17.2 (10.5-23), IV-tPA use 36%, stent-retrievers (SR) 27%, contact aspiration (CA) 27%, combined SR+CA 43%) were included. The median (IQR) number of passes was 1 (1-2). FPE was achieved in 39.3% of the cases. There was no association between percent histological composition or clot richness and FPE in the overall population. However, the combined technique resulted in lower FPE rates for red blood cell (RBC)-rich (P<0.0001), platelet-rich (P=0.003), and mixed (P<0.0001) clots. Fibrin-rich and platelet-rich clots required a higher number of passes than RBC-rich and mixed clots (median 2 and 1.5 vs 1, respectively; P=0.02). CA showed a trend towards a higher number of passes with fibrin-rich clots (2 vs 1; P=0.12). By gross appearance, mixed/heterogeneous clots had lower FPE rates than red and white clots. Conclusions Despite the lack of correlation between clot histology and FPE, our study adds to the growing evidence supporting the notion that clot composition influences recanalization treatment strategy outcomes.
KW - Device
KW - Stroke
KW - Thrombectomy
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U2 - 10.1136/jnis-2023-020117
DO - 10.1136/jnis-2023-020117
M3 - Article
C2 - 37419694
AN - SCOPUS:85165304800
SN - 1759-8478
VL - 16
SP - 466
EP - 470
JO - Journal of neurointerventional surgery
JF - Journal of neurointerventional surgery
IS - 5
ER -