Analyses of thrombi in acute ischemic stroke: A consensus statement on current knowledge and future directions

Author:

De Meyer Simon F1,Andersson Tommy234,Baxter Blaise5,Bendszus Martin6,Brouwer Patrick3,Brinjikji Waleed7,Campbell Bruce CV8,Costalat Vincent9,Dávalos Antoni10,Demchuk Andrew11,Dippel Diederik12,Fiehler Jens13,Fischer Urs14,Gilvarry Michael15,Gounis Matthew J16,Gralla Jan17,Jansen Olav18,Jovin Tudor19,Kallmes David7,Khatri Pooja20,Lees Kennedy R21,López-Cancio Elena10,Majoie Charles22,Marquering Henk2223,Narata Ana Paula24,Nogueira Raul25,Ringleb Peter26,Siddiqui Adnan27,Szikora István28,Vale David15,von Kummer Rüdiger29,Yoo Albert J30,Hacke Werner31,Liebeskind David S32

Affiliation:

1. Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium

2. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden

3. Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden

4. Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium

5. Department of Radiology, Erlanger Hospital, University of Tennessee, Chattanooga

6. Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany

7. Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA

8. Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, VIC 3050, Australia

9. Interventional and Diagnostic Neuroradiology, Montpellier University Hospital, Montpellier, France

10. Acute Stroke Unit, Department of Neurosciences, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain

11. Department of Clinical Neurosciences and Radiology, Cumming School of Medicine, University of Calgary, Canada

12. Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands

13. Department of Neuroradiology, University Medical Center, Hamburg, Germany

14. Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

15. Neuravi Thromboembolic Initiative, Neuravi Ltd, Galway, Ireland

16. Division of Neuroimaging and Intervention and New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA

17. Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

18. Department of Radiology and Neuroradiology, UKSH, Kiel, Germany

19. Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

20. Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA

21. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, UK

22. Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands

23. Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands

24. Department of Neuroradiology, CHRU Hôpitaux de Tours, France

25. Department of Neurology, Emory University, Atlanta, Georgia, USA

26. Department of Neurology, University of Heidelberg, Heidelberg, Germany

27. Department of Neurosurgery, University of Buffalo, Buffalo, New York, USA

28. Department of Neuroradiology, National Institute of Neurosciences, Budapest, Hungary

29. Universitätsklinikum Carl Gustav Carus, Dresden, Germany

30. Texas Stroke Institute, Dallas, TX, USA

31. Department of Neurology, University Hospital Heidelberg, Ruprecht-Karls University, Heidelberg, Germany

32. Neurovascular Imaging Research Core and UCLA Stroke Center, University of California, Los Angeles, California, USA

Abstract

Limited data exist on clot composition and detailed characteristics of arterial thrombi associated with large vessel occlusion in acute ischemic stroke. Advances in endovascular thrombectomy and related imaging modalities have created a unique opportunity to analyze thrombi removed from cerebral arteries. Insights into thrombus composition, etiology, physical properties and neurovascular interactions may lead to future advancements in acute ischemic stroke treatment and improved clinical outcomes. Advances in imaging techniques may enhance clot characterization and inform therapeutic decision-making prior to treatment and reveal stroke etiology to guide secondary prevention. Current imaging techniques can provide some information about thrombi, but there remains much to evaluate about relationships that may exist among thrombus composition, occlusion characteristics and treatment outcomes. Improved pathophysiological characterization of clot types, their properties and how these properties change over time, together with clinical correlates from ongoing studies, may facilitate revascularization with thrombolysis and thrombectomy. Interdisciplinary approaches covering clinical, engineering and scientific aspects of thrombus research will be key to advancing the understanding of thrombi and improving acute ischemic stroke therapy. This consensus statement integrates recent research on clots and thrombi retrieved from cerebral arteries and provides a rationale for further analyses, including current opportunities and limitations.

Publisher

SAGE Publications

Subject

Neurology

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