Impact of Mechanical Thrombectomy Device on Thrombus Histology in Acute Embolic Stroke

Horie, Nobutaka; Shobayashi, Kazuya; Morofuji, Yoichi; Sadakata, Eisaku; Iki, Yusuke; Matsunaga, Yuki; Kanamoto, Tadashi; Tateishi, Yohei; Izumo, Tsuyoshi; Anda, Takeo; Morikawa, Minoru; Tsujino, Akira; Matsuo, Takayuki

doi:10.1016/j.wneu.2019.08.130

Cited by 11 publications

(20 citation statements)

References 12 publications

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“…Bridging tPA treatment before endovascular thrombectomy was associated with a significantly greater erythrocyte composition and lower fibrin composition. 47,54,55 The thinning of fibrin layers was more common in patients treated with bridging IV tPA. 56 In another study, the histologic characteristics of thrombus did not differ between patients who received bridging IV tPA therapy and those who did not.…”

Section: Thrombus Composition In Patients Receiving Intravenous Thrombolysismentioning

confidence: 99%

Pathophysiologic and Therapeutic Perspectives Based on Thrombus Histology in Stroke

et al. 2020

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Recent advances in endovascular thrombectomy have enabled the histopathologic analysis of fresh thrombi in patients with acute stroke. Histologic analysis has shown that the thrombus composition is very heterogeneous between patients. However, the distribution pattern of each thrombus component often differs between patients with cardiac thrombi and those with arterial thrombi, and the efficacy of endovascular thrombectomy is different according to the thrombus composition. Furthermore, the thrombus age is related to the efficacy of reperfusion therapy. Recent studies have shown that neutrophils and neutrophil extracellular traps contribute to thrombus formation and resistance to reperfusion therapy. Histologic features of thrombi in patients with stroke may provide some clues to stroke etiology, which is helpful for determining the strategy of stroke prevention. Research on thrombus may also be helpful for improving reperfusion therapy, including the development of new thrombolytic agents.

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Section: Thrombus Composition In Patients Receiving Intravenous Thrombolysismentioning

confidence: 99%

Pathophysiologic and Therapeutic Perspectives Based on Thrombus Histology in Stroke

et al. 2020

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“…Given their findings, investigators concluded that stent retrieving does not cause relevant intimal damage, and endothelial cells found in thrombi might be the hint of the physiological turnover of endothelium or of an initial organization of the thrombus. On the other hand, in a larger series, vessel wall components were found, with a different histological technique, in 16% of analyzed specimens; moreover, parts of internal elastic lamina were present in 12 out of 150 thrombi, suggesting an involvement of the tunica media by MT-induced vascular injury [64] . These contrasting results require confirmation by other studies with standardized histological analysis.…”

Section: Procedural Complicationsmentioning

confidence: 85%

“…Although very effective, MT is an invasive procedure that can be traumatic for the cerebral vessel wall. Endovascular procedure traumatism has been proved by the presence in specimens of CD34-positive endothelial cells [63] or banded collagen fibers with distinct boundary existing at the margin or outside of the thrombus [64] .…”

Section: Procedural Complicationsmentioning

confidence: 99%

“…These contrasting results require confirmation by other studies with standardized histological analysis. Interestingly, the presence of vessel wall components in thrombi was associated with a higher number of passages, more distal location of the occlusion (specifically M2 and P2), and low content of RBCs [64] , suggesting that more complex procedures might cause wall damage.…”

Section: Procedural Complicationsmentioning

confidence: 99%

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Histological analysis of thrombi retrieved after acute ischemic stroke from large vessel occlusion: from research to clinical practice

Nicolini¹,

Michele²,

Falcou³

et al. 2022

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Emergent reperfusion therapies have improved acute ischemic stroke prognosis, but many patients are still bound to bad clinical outcome, probably because of our incomplete knowledge of its pathophysiology. Thanks to mechanical thrombectomy, occluding material is available for histological analysis. Several studies investigated the possible relationship between thrombus composition and clinical, procedural, and radiological variables of acute ischemic stroke. The potential value of thrombus analysis as a tool for clinical practice and research is still not defined, as data from the literature are heterogeneous and sometimes conflicting. We propose a review of the existing literature regarding histological analysis of thrombi in acute ischemic stroke. We classified articles on clot composition according to the clinical variable explored in each study. We first distinguished articles about etiology, procedural, and radiological variables, and then we performed a subclassification for each group. This review could help both in the interpretation of thrombus analysis in clinical practice and in its usage for future research.

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“…29,30 Besides, a recent study suggested that thrombectomy strategies could also affect clot composition. 31 We adopted both SR and CA for AIS patients in this study, while only the aspiration technique was used for coronary thrombus. As a result, the different effects of DM on coronary and AIS thrombus might be due to the differences in mechanism and duration of thrombosis, and thrombectomy strategies.…”

Section: Discussionmentioning

confidence: 99%

The role of diabetes mellitus on the thrombus composition in patients with acute ischemic stroke

Gao

et al. 2020

Interv Neuroradiol

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Purpose Diabetes mellitus indicated poor clinical prognosis for patients with acute ischemic stroke. Furthermore, diabetes mellitus could also impact the hemostatic system, while its influence on the histological composition of thrombus is unclear. Methods Consecutive patients with retrieved clots were included. Histologic staining for thrombus included hematoxylin and eosin, Martius Scarlet Blue, immunohistochemistry for von Willebrand factor. The differences in clot composition were compared according to diabetes mellitus history or hyperglycemia (≥7.8 mmol/L) on admission. Results A total of 52 patients were included; half of them were diagnosed as diabetes mellitus previously. Diabetic patients showed higher serum glucose on admission (8.90 vs. 7.40, p = 0.012). The baseline characteristics (expect smoking history and thrombus location), procedural, and clinical outcomes were similar between diabetic patients and nondiabetic patients. As for histologic composition, thrombus in patients with diagnosed diabetes mellitus had more fibrin (44.2% vs. 28.3%, p = 0.004) and fewer red blood cells (26.0% vs. 42.9%, p = 0.013) and equivalent content of platelets (24.0% vs. 21.5%, p = 0.694) and von Willebrand factor (0.041 vs. 0.031, p = 0.234) than patients without diabetes mellitus. However, there was no statistical difference in the content of red blood cells (41.6% vs. 27.3%, p = 0.105), fibrin (37.6% vs. 34.3%, p = 0.627), platelets (21.2% vs. 24.2%, p = 0.498), and von Willebrand factor (0.038 vs. 0.034, p = 0.284) between patients with or without hyperglycemia on admission. Conclusion Clots in diabetic patients had more fibrin and fewer erythrocyte components compared with patients without diabetes mellitus, while hyperglycemia on admission did not show association with clot composition. Further studies are needed to confirm these results.

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Impact of Mechanical Thrombectomy Device on Thrombus Histology in Acute Embolic Stroke

Cited by 11 publications

References 12 publications

Pathophysiologic and Therapeutic Perspectives Based on Thrombus Histology in Stroke

Pathophysiologic and Therapeutic Perspectives Based on Thrombus Histology in Stroke

Histological analysis of thrombi retrieved after acute ischemic stroke from large vessel occlusion: from research to clinical practice

The role of diabetes mellitus on the thrombus composition in patients with acute ischemic stroke

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