Per-Pass Analysis of Thrombus Composition in Patients With Acute Ischemic Stroke Undergoing Mechanical Thrombectomy

Abstract

Background and Purpose— Mechanical thrombectomy may involve multiple attempts to retrieve the occluding thrombus. This study examined the composition of thrombus fragments retrieved with each pass of a device during the thrombectomy procedure. Second, the per-pass composition was compared with procedural and clinical data including angiographic outcome and stroke etiology. Methods— Thrombi were retrieved from 60 patients with acute ischemic stroke, where thrombus fragments retrieved in each pass were segregated as individual samples and maintained throughout the histological analysis as independent samples. All samples were stained with hematoxylin and eosin and Martius Scarlet Blue. The relative composition of red blood cells, fibrin, and white blood cells in thrombus fragments from each pass was quantified. Results— Over the 60 cases, thrombus material was retrieved in 106 of 138 passes. The number of passes required to complete the cases ranged from 1 to 6 passes. The analysis of thrombus fragments retrieved in each pass provided a greater insight into the thrombectomy procedure progression than the overall thrombus composition; the red blood cell content of thrombus fragments retrieved in passes 1 and 2 was significantly higher than that retrieved in passes 3 to 6. The removal of thrombus material in a total of 1, 2, or 3 passes was associated with the highest percentage of final modified Thrombolysis in Cerebral Infarction score of 2c-3. There was no association between modified Thrombolysis in Cerebral Infarction score and per-pass thrombus composition. Conclusions— The differentiation achieved through the per-pass analysis of acute ischemic stroke thrombi provides a greater insight into the thrombectomy procedure progression than the combined per-case thrombus analysis. Insights gained may be a useful consideration in determining the treatment strategy as a case evolves and may be useful for the development of new devices to increase rates of 1-pass recanalization.

Clot-Based Radiomics Predict a Mechanical Thrombectomy Strategy for Successful Recanalization in Acute Ischemic Stroke

“…Indeed, thrombi with a high red blood cell content are removed more rapidly 25 and with significantly less MTB passages than thrombi with a low content. 26 These insights into clot composition appear to be useful for the selection of the endovascular treatment strategy, as well as for the development of new treatment methods. The different compositions of these intracranial clots also seem to be reflected in their CT or magnetic resonance imaging characteristics where red blood cell and fibrin levels influence the appearance of the clot.…”

Effect of the phenotype of the M1-middle cerebral artery occlusion on the recanalization rates in the ASTER trial

“…However, histological data are needed to confirm this hypothesis. Indeed, some authors have pointed out that the histological analysis of the retrieved clot could explain different responses to the endovascular treatment,23 24 although a consensus about the interpretation of these results has not yet been achieved. Furthermore, the performance of imaging biomarkers is too often questioned on their ability to correlate with results of classical histopathologic quantification that are difficult to interpret because of the random sampling of parts of heterogeneous thrombi which, moreover, are not available in all cases.…”

Cancer-Related Stroke: An Emerging Subtype of Ischemic Stroke with Unique Pathomechanisms

“…77 However, further studies with a larger cohort are needed and a recent study showed that although retrieved thrombi may provide useful information on the treatment strategy, the components of retrieved thrombi could be changed during the thrombectomy procedure. 78…”