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

Autar, Anouchska; Hund, Hajo; Ramlal, Sharad; Hansen, Daniel; Nijeholt, Geert J. Lycklama à; Emmer, Bart J.; Maat, Moniek P.M. de; Dippel, Diederik W.J.; Lugt, Aad van der; Es, Adriaan C.G.M. van; Beusekom, Heleen M.M. van; Investigators, Clean Registry

doi:10.1161/jaha.118.008563

Cited by 14 publications

(8 citation statements)

References 25 publications

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“…In agreement with these unpublished findings, many studies have presented evidence of film in thrombi. Scanning electron microscopy (SEM) micrographs of thrombi from patients with PE, 11 AIS, 12 or MI 13 showed fibrin film in these thrombi. A recent study showed structures surrounding thrombi removed from patients with AIS that had similar properties to fibrin films, which these authors called a shell, and which slowed thrombolysis.…”

Section: Major Thrombus Componentsmentioning

confidence: 99%

Thrombus Structural Composition in Cardiovascular Disease

Alkarithi

Duval

Shi

et al. 2021

ATVB

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Thrombosis is a major complication of cardiovascular disease, leading to myocardial infarction, acute ischemic stroke (AIS), or venous thromboembolism. Thrombosis occurs when a thrombus forms inside blood vessels disrupting blood flow. Developments in thrombectomy to remove thrombi from vessels have provided new opportunities to study thrombus composition which may help to understand mechanisms of disease and underpin improvements in treatments. We aimed to review thrombus compositions, roles of components in thrombus formation and stability, and methods to investigate thrombi. Also, we summarize studies on thrombus structure obtained from cardiovascular patients and animal models. Thrombi are composed of fibrin, red blood cells, platelets, leukocytes, and neutrophil extracellular traps. These components have been analyzed by several techniques, including scanning electron microscopy, laser scanning confocal microscopy, histochemistry, and immunohistochemistry; however, each technique has advantages and limitations. Thrombi are heterogenous in composition, but overall, thrombi obtained from myocardial infarction are composed of mainly fibrin and other components, including platelets, red blood cells, leukocytes, and cholesterol crystals. Thrombi from patients with acute ischemic stroke are characterized by red blood cell- and platelet-rich regions. Thrombi from patients with venous thromboembolism contain mainly red blood cells and fibrin with some platelets and leukocytes. Thrombus composition from patients with myocardial infarction is influenced by ischemic time. Animal thrombosis models are crucial to gain further mechanistic information about thrombosis and thrombus structure, with thrombi being similar in composition compared with those from patients. Further studies on thrombus composition and function are key to improve treatment and clinical outcome of thrombosis.

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Section: Major Thrombus Componentsmentioning

confidence: 99%

Thrombus Structural Composition in Cardiovascular Disease

Alkarithi

Duval

Shi

et al. 2021

ATVB

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“…Meanwhile, many neurologists worldwide agree that although successful reperfusion is important in EVT, too many attempts of stent retrievals might lead to futile recanalization. The reason for this is considered to be a higher erythrocyte fraction in thrombi that might cause an increase in viscosity and decrease in stiffness so that a block of thrombi could be retrieved by thrombectomy, and the other reason may be that erythrocyte-rich thrombi increased the adhesive strength with stent retriever [14][15][16]. Erythrocyte-rich thrombi were found to be associated with favorable clinical outcomes by influencing procedure characteristics, and minimizing procedure time and the primary reason for this was a high rate of successful reperfusion.…”

Section: Discussionmentioning

confidence: 99%

Erythrocyte-rich thrombi related to serum iron contribute to single stent retrieval and favorable clinical outcomes in acute ischemic stroke by endovascular treatment

Liu

Hao

et al. 2020

Thrombosis Research

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Background: Erythrocyte-rich thrombi seem to be associated with favorable clinical outcomes of patients with AIS by endovascular treatment (EVT), as observed from previous studies. However, only few studies show whether erythrocyte-rich thrombi can be associated with favorable clinical outcomes by EVT and which factor can be related to erythrocyte-rich thrombi. This retrospective study aimed to evaluate the relationship between erythrocyte-rich thrombi and favorable clinical outcomes and further explored factors associated with erythrocyte-rich thrombi. Methods: This study was carried out retrospectively from March 2016 to April 2019 on patients who suffered acute ischemic stroke and were treated by EVT at this stroke center. The laboratory test and clinical data were assessed for the relationship between erythrocyte-rich thrombi and favorable clinical outcomes and factors associated with erythrocyte-rich thrombi. All thrombi were divided into erythrocyte-rich thrombi group and fibrinrich thrombi group based on the proportion of area of the predominant composition which was more than 50% in retrieved thrombi. Results: This retrospective study enrolled 84 patients, including 32 patients in the erythrocyte-rich thrombi group and 52 patients in the fibrin-rich thrombi group. It showed single stent retrieval (p = 0.017, adjusted OR: 4.061, 95% CI: 1.281-12.872) and favorable clinical outcomes (p < 0.001, adjusted OR: 14.648, 95% CI: 4.637-46.270) were both significantly associated with erythrocyte-rich thrombi. A significant difference in the factor associated with erythrocyte-rich thrombi was serum iron, which correlated positively with erythrocyte fraction in thrombi (p < 0.001, r: 0.452). Conclusions: Erythrocyte-rich thrombi could contribute to single stent retrieval and favorable clinical outcomes by EVT, and serum iron might be the factor associated with erythrocyte-rich thrombi.

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“…In contrast, an abnormal status in patients with diabetes mellitus may explain the occurrence of single attempt of stent retrieval. It was previously shown that thrombus and stents are adhesive due to the fibrin networks of the dense thrombus surface, determined by a range of initiators of thrombus formation [20]. Patients with diabetes mellitus show accelerated clot initiation caused by platelet activity and hypercoagulation, and adverse reaction milieu characteristics due to diabetes mellitus lead to a dysregulated clotting system [21,22].…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes and Factors of Single Attempt of Stent Retrieval during Endovascular Thrombectomy for Acute Ischemic Stroke

M¹,

Y²,

Liu³

et al. 2020

Preprint

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Backgrounds: Single attempt of stent retrieval during endovascular thrombectomy (EVT) seems to be associated with favorable clinical outcomes of patients with acute ischemic stroke (AIS), but the relationship between single attempt and clinical outcomes or complications have not been characterized. In addition, the factors related to single retrieval attempts during EVT are undefined. Here, we investigated the relationship between single attempt of stent retrieval and the clinical outcomes or complications after EVT, and further investigated the factors associated with single attempt of stent retrieval in AIS patients. Methods: This study enrolled consecutive patients with AIS treated by EVT with second-generation stent retriever devices from April 2016 to April 2019. Attempts of EVT were classified as single or multiple attempts of stent retrieval after filtrating all enrolled patients based on inclusion and exclusion criteria. We analyzed the clinical outcomes and complications between single attempt of stent retrieval and multiple attempts of stent retrieval, and the factors independently associated with a single attempt were identified through logistical regression analysis. Results: We enrolled 143 patients, including 69 patients with single attempt of stent retrieval and 74 patients with multiple attempts of stent retrieval. More patients with single attempt of stent retrieval reached favorable clinical outcomes ( p =0.016; adjusted OR [95%CI]: 2.652 [1.204-5.843] ), and patients with single attempts of stent retrieval showed as a lower incidence of symptomatic intracranial hemorrhage (sICH) ( p =0.046; adjusted OR [95%CI]: 0.192 [0.038-0.973] ). Diabetes mellitus ( p =0.026; adjusted OR [95%CI]: 2.871 [1.137-7.249] ) was independently associated with single attempt of EVT with stent retrieval. Conclusions: Single attempt of stent retrieval during EVT can decrease incidence of sICH and improve favorable clinical outcomes of patients with AIS. Those with diabetes mellitus may be more prone to single attempt of stent retrieval during EVT .

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

Cited by 14 publications

References 25 publications

Thrombus Structural Composition in Cardiovascular Disease

Thrombus Structural Composition in Cardiovascular Disease

Erythrocyte-rich thrombi related to serum iron contribute to single stent retrieval and favorable clinical outcomes in acute ischemic stroke by endovascular treatment

Clinical Outcomes and Factors of Single Attempt of Stent Retrieval during Endovascular Thrombectomy for Acute Ischemic Stroke

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