Imaging of Occlusive Thrombi in Acute Ischemic Stroke

Gasparian, Gregory; Sanossian, Nerses; Shiroishi, Mark S.; Liebeskind, David S

doi:10.1111/ijs.12435

Cited by 29 publications

(29 citation statements)

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“…Clot composition has been assessed ex vivo4 5 24 to determine a potential relationship between thrombus histology and difficulty of clot removal. Many medical imaging studies attempting to determine the difficulty of clot removal based on predicting the composition of clots using CT or MRI have also been carried out 18 25–27. However, the quantitative histological measurement of RBC and fibrin composition in this study failed to distinguish clots based on their mechanical properties.…”

Section: Discussionmentioning

confidence: 77%

Mechanical behavior of in vitro blood clots and the implications for acute ischemic stroke treatment

Johnson

Chueh

Gounis

et al. 2019

J NeuroIntervent Surg

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BackgroundClot mechanical properties are influenced by composition and the arrangement of components within the clot. This work investigates the effects of platelet-driven contraction on blood clot microstructure and mechanical behavior, and provides insight into some implications for mechanical thrombectomy.MethodsPlatelet-contracted clot analogues (PCCs) and non-contracted clot analogues (NCCs) were prepared from blood mixtures of various hematocrits (%H), that is, the volume percentage of red blood cells (RBCs) in the mixture. Mechanical testing was performed to compare the behavior of the analogues with previously tested human thromboemboli. Scanning electron microscopy and histology investigated the clot microstructure and composition. The association between clot properties and their behavior during mechanical behavior was also investigated.ResultsOverall, PCCs were found to be stiffer than NCCs, across all hematocrits. PCCs with a low %H resisted complete ingestion via contact aspiration alone or complete retrieval with stent-retrievers. PCCs with a higher %H and all NCCs were fully retrievable, although the likelihood of fragmentation was increased in clots with a greater %H. Histologically, there was little difference in the RBC and fibrin content between PCCs and NCCs with the same %H. However, the microstructure of the two groups differed significantly.ConclusionA selection of repeatable clot analogues with a range of mechanical properties have been developed for in vitro modeling of acute ischemic stroke. Platelet contraction significantly affects clot volume and microstructure, and in turn clot stiffness. The significant difference in mechanical properties and microstructure, but without an appreciable difference in histology, implies that histological studies of explanted human clots alone may not prove to be predictive of the mechanical behavior of the clots in thrombectomy.

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Section: Discussionmentioning

confidence: 77%

Mechanical behavior of in vitro blood clots and the implications for acute ischemic stroke treatment

Johnson

Chueh

Gounis

et al. 2019

J NeuroIntervent Surg

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“…PSCs had an overall greater rate of multimodal imaging use among hyperacute stroke patients than nonstroke centers from 2005 to 2012, though in the period 2011–2012, the proportion of patients who received multimodal imaging were comparable between PSCs and nonstroke centers. Multimodal imaging has the potential to more accurately evaluate those patients with acute stroke who are eligible for endovascular therapy and may also have more successful outcomes after thrombectomy, facilitating improved therapeutic decision‐making with these noninvasive studies . While rates of multimodal imaging use continue to be relatively low, their increase over the last decade may reflect a trend toward their use for not only diagnostic purposes, but also therapeutic decision making in the thrombectomy era.…”

Section: Discussionmentioning

confidence: 99%

Utilization of Emergent Neuroimaging for Thrombolysis‐Eligible Stroke Patients

Sanossian

Liebeskind

et al. 2016

Journal of Neuroimaging

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Background Advances in diagnostic imaging of stroke include multimodal techniques such as noninvasive angiography and perfusion imaging. We aimed to characterize trends in neuroimaging utilization among acute stroke patients. Utilization of multimodal imaging for acute stroke in the community has remained largely uncharacterized despite its increased adoption at academic medical centers. Methods We quantified neuroimaging utilization in the emergency department for 1700 hyperacute stroke patients presenting <2 hours after symptom onset who participated in the National Institutes of Health Field Administration of Stroke Therapy Magnesium (FAST-MAG) study throughout Los Angeles and Orange Counties. FAST-MAG provided no recommendation as to imaging utilization. Results 1700 cases were imaged a median (Interquartile range: IQR) of 92 (74–120) minutes after last known well time and 28 (19–41) minutes after ED arrival. The initial scanner used in the ED was CT in a preponderance of cases (N=1612, 95%), with MRI in 88 cases (5%). CT angiography was obtained in 192 (11%) and perfusion CT in 91 (5.4%) cases. MRI imaging was universally obtained using diffusion-weighted images, 60% with MR angiography and 33% included perfusion imaging. Rates of concomitant CTA or CTP use increased in the later years of the study from 4% in 2005–2006, 2% in 2007–2008, 8% in 2009–2010 and 26% in 2011–2012 (p for trend <0.001). Conclusions Among acute stroke patients, non-contrast CT was the most common initial imaging strategy in clinical practice in the 2005–2012 time period, though use of concomitant CTA grew to one-quarter of cases, suggestive of an upward trend.

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“…Besides, the presence of hyperdense middle cerebral artery (MCA) sign on NCCT was verified by two cerebrovascular disease specialists and manually drawn through FMRIB Software Library (FSL) (Smith et al, 2004;Jenkinson et al, 2012). This sign is a direct visualization of thromboembolic material within the vessel lumen, which has been reported as a specific and important sign for intravascular thrombus in the diagnosis of AIS and LVO (Gasparian et al, 2015).…”

Section: Study Population and Data Acquisitionmentioning

confidence: 97%