Clot composition and recanalization outcomes in mechanical thrombectomy
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Published:2023-07-07
Issue:
Volume:
Page:jnis-2023-020117
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ISSN:1759-8478
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Container-title:Journal of NeuroInterventional Surgery
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language:en
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Short-container-title:J NeuroIntervent Surg
Author:
Nogueira Raul GORCID, Pinheiro AgostinhoORCID, Brinjikji WaleedORCID, Abbasi Mehdi, Al-Bayati Alhamza RORCID, Mohammaden Mahmoud H, Souza Viana LorenaORCID, Ferreira Felipe, Abdelhamid Hend, Bhatt Nirav RORCID, Kvamme Peter, Layton Kennith F, Delgado Almandoz Josser E, Hanel Ricardo A, Mendes Pereira VitorORCID, Almekhlafi Mohammed AORCID, Yoo Albert J, Jahromi Babak SORCID, Gounis Matthew JORCID, Patel Biraj, Arturo Larco Jorge LORCID, Fitzgerald Sean, Mereuta Oana MadalinaORCID, Doyle KarenORCID, Savastano Luis E, Cloft Harry J, Thacker Ike C, Kayan Yasha, Copelan Alexander, Aghaebrahim Amin, Sauvageau Eric, Demchuk Andrew M, Bhuva Parita, Soomro Jazba, Nazari PouyaORCID, Cantrell Donald Robert, Puri Ajit S, Entwistle John, Polley Eric C, Frankel Michael R, Kallmes David F, Haussen Diogo C
Abstract
BackgroundMechanical 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.MethodsClinical, 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.ResultsA 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.ConclusionsDespite 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.
Subject
Neurology (clinical),General Medicine,Surgery
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