Impact of histological clot composition on preprocedure imaging and mechanical thrombectomy

Johnson, Jeremiah N.; Srivatsan, Aditya; Chueh, Juyu; Arslanian, Rose; Gounis, Matthew J.; Puri, Ajit S; Srinivasan, Visish M.; Chen, Stephen Russell; Burkhardt, Jan‐Karl; Kan, Peter

doi:10.4103/bc.bc_81_21

Cited by 7 publications

(3 citation statements)

References 24 publications

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“…The role of preoperative D-dimer levels identified by Baek et al was confirmed in our study, with elevated levels predicting a predisposition to poor outcomes after EVT [33]. High D-dimer level reflects the existence of hard or fibrin-rich thrombus, which usually requires more passes of the thrombectomy devices and a longer time from groin puncture to recanalization [34,35]. The results of this study are in line with them, further guiding neurointerventionists to adjust their surgical strategies if they find that baseline D-dimer is elevated in AIS patients.…”

Section: Discussionsupporting

confidence: 76%

A Comprehensive Prediction Model for Futile Recanalization in AIS Patients Post-Endovascular Therapy: Integrating Clinical, Imaging, and No-Reflow Biomarkers

2024

Aging dis

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Our study aimed to construct a predictive model for identifying instances of futile recanalization in patients with anterior circulation occlusion acute ischemic stroke (AIS) who achieved complete reperfusion following endovascular therapy. We included 173 AIS patients who attained complete reperfusion, as indicated by a Modified Thrombolysis in Cerebral Infarction (mTICI) scale score of 3. Our approach involved a thorough analysis of clinical factors, imaging biomarkers, and potential no-reflow biomarkers through both univariate and multivariate analyses to identify predictors of futile recanalization. The comprehensive model includes clinical factors such as age, presence of diabetes, admission NIHSS score, and the number of stent retriever passes; imaging biomarkers like poor collaterals; and potential no-reflow biomarkers, notably disrupted blood-brain barrier (OR 4.321, 95% CI 1.794-10.405; p = 0.001), neutrophil-to-lymphocyte ratio (NLR; OR 1.095, 95% CI 1.009-1.188; p = 0.030), and D-dimer (OR 1.134, 95% CI 1.017-1.266; p = 0.024). The model demonstrated high predictive accuracy, with a C-index of 0.901 (95% CI 0.855-0.947) and 0.911 (95% CI 0.863-0.954) in the original and bootstrapping validation samples, respectively.Notably, the comprehensive model showed significantly improved predictive performance over models that did not include no-reflow biomarkers, evidenced by an integrated discrimination improvement of 8.86% (95% CI 4.34%-13.39%; p < 0.001) and a categorized reclassification improvement of 18.38% (95% CI 3.53%-33.23%; p = 0.015). This model, which leverages the potential of no-reflow biomarkers, could be especially beneficial in healthcare settings with limited resources. It provides a valuable tool for predicting futile recanalization, thereby informing clinical decision-making. Future research could explore further refinements to this model and its application in diverse clinical settings.

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Section: Discussionsupporting

confidence: 76%

A Comprehensive Prediction Model for Futile Recanalization in AIS Patients Post-Endovascular Therapy: Integrating Clinical, Imaging, and No-Reflow Biomarkers

2024

Aging dis

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“…The makeup of the clot plays a role in the ability to break it up. Fibrin-rich or calcific clots are much more difficult to break up than clots that are made up mostly of red blood cells (RBCs) 46. Regardless, studies have shown that a lower number of attempts to recanalize, or “passes,” is associated with better outcomes.…”

Section: Lessons From Mechanical Thrombectomymentioning

confidence: 99%

Toward Faster Revascularization in Large Vessel Acute Ischemic Stroke: Reducing Door-to-Groin Puncture Times

Rangel,

Krishna,

Bendok

et al. 2023

Contemporary Neurosurgery

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Stroke treatment has evolved immensely over the past 3 decades, with mechanical thrombectomy becoming the mainstay of treatment for large vessel occlusion (LVO). In this review, we describe the progression from PROACT I to the present day, and analyze existing literature to summarize the efficacy of current methods to treat LVO. We also describe the indications for mechanical thrombectomy and the strategies that have been implemented to enhance its efficacy, including a quality improvement project conducted at the Mayo Clinic. In addition, we discuss lessons from the implementation of mechanical thrombectomy and advancements in this technique over recent years.

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“…Fibrin-rich or calcific clots are much more difficult to break up than clots that are made up mostly of red blood cells (RBCs). 46 Regardless, studies have shown that a lower number of attempts to recanalize, or "passes," is associated with better outcomes. More than 3 passes often lead to higher rates of hematomas and lower rates of reperfusion.…”

Section: Lessons From Mechanical Thrombectomymentioning

confidence: 99%

Toward Faster Revascularization in Large Vessel Acute Ischemic Stroke: Reducing Door-to-Groin Puncture Times

2023

Contemporary Neurosurgery

View full text Add to dashboard Cite

Impact of histological clot composition on preprocedure imaging and mechanical thrombectomy

Cited by 7 publications

References 24 publications

A Comprehensive Prediction Model for Futile Recanalization in AIS Patients Post-Endovascular Therapy: Integrating Clinical, Imaging, and No-Reflow Biomarkers

A Comprehensive Prediction Model for Futile Recanalization in AIS Patients Post-Endovascular Therapy: Integrating Clinical, Imaging, and No-Reflow Biomarkers

Toward Faster Revascularization in Large Vessel Acute Ischemic Stroke: Reducing Door-to-Groin Puncture Times

Toward Faster Revascularization in Large Vessel Acute Ischemic Stroke: Reducing Door-to-Groin Puncture Times

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