Novel methodology to replicate clot analogs with diverse composition in acute ischemic stroke

Duffy, Sharon; Farrell, Michael; McArdle, Kevin; Thornton, John; Vale, David; Rainsford, Eleanor; Morris, Liam; Liebeskind, David S; MacCarthy, Eugene; Gilvarry, Michael

doi:10.1136/neurintsurg-2016-012308

Cited by 97 publications

(91 citation statements)

References 29 publications

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“…The resistant fibrin rich clot analogues were produced from ovine blood based on the methodology described by Duffy et al 7. Briefly, ovine blood was anticoagulated using sodium citrate solution immediately after collection.…”

Section: Methodsmentioning

confidence: 99%

What to do about fibrin rich ‘tough clots’? Comparing the Solitaire stent retriever with a novel geometric clot extractor in an in vitro stroke model

Fennell

Nagesh

Meess

et al. 2018

J NeuroIntervent Surg

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Section: Methodsmentioning

confidence: 99%

What to do about fibrin rich ‘tough clots’? Comparing the Solitaire stent retriever with a novel geometric clot extractor in an in vitro stroke model

Fennell

Nagesh

Meess

et al. 2018

J NeuroIntervent Surg

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“…Several studies analyzing clots retrieved from patients have shown that the ratio of fibrin to RBC content can vary from 100% fibrin to almost 80% RBCs 12–14. In our laboratory, we have created a variety of blood clots of different compositions (from 0% to 80% RBC content) based on strict protocols, previously described by our group 15. Some mechanical characterization of clots has been investigated in the past, including tensile, compressive, and rheological properties 16 17.…”

Section: Introductionmentioning

confidence: 99%

Clot friction variation with fibrin content; implications for resistance to thrombectomy

Gunning¹,

McArdle²,

Mirza³

et al. 2017

J NeuroIntervent Surg

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“…This is supported by studies that compared the occurrence of the HVS with histological analyses of thrombus formations, proving that thrombus density in CT is proportional to the RBC content and inversely proportional to its fibrin content [14][15][16]. It was also shown that thrombus compositions are associated with its origin and result from the duration of the occlusion [17,18]. Most in-or ex vivo CT studies investigated thrombus composition and the relation to characteristics within unenhanced CT scans (NECT) [10,11,15,19,20].…”

Section: Introductionmentioning

confidence: 74%

Thrombus Enhancement Is a Predictor of Clinical Outcome in Acute Ischemic Stroke after Mechanical Thrombectomy

et al. 2018

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Background: Ex vivo computed tomography (CT) studies of artificial blood thrombi showed that contrast enhancement (CE) is determined by fibrin-content, while unenhanced density is associated with red blood cells. Thus, the present study investigates patient outcome in association with combined thrombus density measures in native and contrast-enhanced CT (CECT) of acute ischemic stroke patients. Methods: This retrospective study includes 137 patients with M1 occlusions treated by mechanical thrombectomy (MT) between 2010 and 2016. Clinical outcome was determined with modified Rankin Scale (mRS) at 90 days. Differentiation of complete and incomplete large vessel occlusion (CLVO/ILVO) was based on CT and angiography. Two blinded readers classified blood thrombi based on native non-enhanced CT (NECT) as (a) hypo-, (b) iso-, and (c) hyperdense and in CECT angio measurements as (d) not-enhancing, (e) intermediate and (f) enhancing. To make sure that the mean is not represented in any of the maximum/minimum groups, thresholds in both cases were selected in a way that all values within one SD around the mean value form the isodense/intermediate group. In addition, the CE per se was correlated with the outcome. Correlations between imaging and clinical scales were performed with Spearman’s Rho. For the group testing Pearson chi-square test, Mann-Whitney U, as well parametric and nonparametric one-factor ANOVA “Kruskal-Wallis” test including Bonferroni correction for multiple tests ware used. Results: Twenty-three patients with ILVO (16.8%) differed significantly from patients with CLVO in mRS at admission (median 4 vs. 5) and after 90 days (median 1 vs. 4; p < 0.05) and thus were excluded. In the ILVO cohort, the classification according to NECT did not show statistical difference between hypo-, iso- and hyperdense CLVOs in regard to outcome. Classification of CLVOs according to CECT allowed an outcome prediction between the intermediate (median 3) and enhancing group (median 5) and between the enhancing and non-enhancing group (median 3; both p < 0.05) with a correlation of 291 between CE and higher mRS after 90 days (p < 0.005). Conclusions: CE of thrombi – especially in a range from over 18.4 to 40.35 Hounsfield Units – is an independent predictor of poor clinical outcome in patients undergoing MT due to acute middle cerebral artery occlusion.

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Novel methodology to replicate clot analogs with diverse composition in acute ischemic stroke

Abstract: Seven different clot types were developed to replicate common AIS thrombi. These clot analogs may be beneficial for the preclinical evaluation of endovascular therapies, and may be applied to interventional technique training.

Cited by 97 publications

References 29 publications

What to do about fibrin rich ‘tough clots’? Comparing the Solitaire stent retriever with a novel geometric clot extractor in an in vitro stroke model

What to do about fibrin rich ‘tough clots’? Comparing the Solitaire stent retriever with a novel geometric clot extractor in an in vitro stroke model

Clot friction variation with fibrin content; implications for resistance to thrombectomy

Thrombus Enhancement Is a Predictor of Clinical Outcome in Acute Ischemic Stroke after Mechanical Thrombectomy

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