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Fibrin Clot Architecture in Acute Ischemic Stroke Treated With Mechanical Thrombectomy With Stent-Retrievers - Cohort Study

D. Krajíčková, A. Krajina, I. Šteiner, O. Vyšata, R. Herzig, M. Lojík, V. Chovanec, J. Raupach, O. Renc, J. Waishaupt, E. Vítková, P. Dulíček, P. Čabelková, M. Vališ,

. 2018 ; 82 (3) : 866-873. [pub] 20171123

Language English Country Japan

Document type Journal Article, Observational Study, Research Support, Non-U.S. Gov't

Persistent link   https://www.medvik.cz/link/bmc19028686

BACKGROUND: The composition of intra-arterial clots might influence the efficacy of mechanical thrombectomy (MT) in ischemic stroke (IS) due to the acute occlusions within large cerebral arteries. The aims were to assess the factors associated with blood clot structure and the impact of thromboembolus structure on MT using stent-retrievers in patients with acute large artery IS in the anterior circulation.Methods and Results:In an observational cohort study, we studied the components of intra-arterial clots retrieved from large cerebral arteries in 80 patients with acute IS treated with MT with or without i.v. thrombolysis (IVT). Histology of the clots was carried out without knowledge of the clinical findings, including the treatment methods. The components of the clots, their age, origin and semi-quantitative graded changes in the architecture of the fibrin components (e.g., "thinning") were compared via neuro-interventional, clinical and laboratory data. The most prominent changes in the architecture of the fibrin components in the thromboemboli were associated with IVT (applied in 44 patients; OR, 3.50; 95% CI: 1.21-10.10, P=0.02) and platelet count (OR, 2.94; 95% CI: 1.06-8.12, P=0.04). CONCLUSIONS: In patients with large artery IS treated with the MT using stent-retrievers, bridging therapy with IVT preceding MT and higher platelet count were associated with significant changes of the histological structure of blood clots.

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$a BACKGROUND: The composition of intra-arterial clots might influence the efficacy of mechanical thrombectomy (MT) in ischemic stroke (IS) due to the acute occlusions within large cerebral arteries. The aims were to assess the factors associated with blood clot structure and the impact of thromboembolus structure on MT using stent-retrievers in patients with acute large artery IS in the anterior circulation.Methods and Results:In an observational cohort study, we studied the components of intra-arterial clots retrieved from large cerebral arteries in 80 patients with acute IS treated with MT with or without i.v. thrombolysis (IVT). Histology of the clots was carried out without knowledge of the clinical findings, including the treatment methods. The components of the clots, their age, origin and semi-quantitative graded changes in the architecture of the fibrin components (e.g., "thinning") were compared via neuro-interventional, clinical and laboratory data. The most prominent changes in the architecture of the fibrin components in the thromboemboli were associated with IVT (applied in 44 patients; OR, 3.50; 95% CI: 1.21-10.10, P=0.02) and platelet count (OR, 2.94; 95% CI: 1.06-8.12, P=0.04). CONCLUSIONS: In patients with large artery IS treated with the MT using stent-retrievers, bridging therapy with IVT preceding MT and higher platelet count were associated with significant changes of the histological structure of blood clots.
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$a Krajina, Antonín $u Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital.
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$a Šteiner, Ivo $u The Fingerland Department of Pathology, University Hospital.
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$a Vyšata, Oldřich $u Department of Neurology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital.
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$a Lojík, Miroslav $u Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital.
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$a Chovanec, Vendelín $u Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital.
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$a Raupach, Jan $u Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital.
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$a Renc, Ondřej $u Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital.
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$a Waishaupt, Jan $u Department of Neurology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital.
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$a Dulíček, Petr $u Fourth Department of Internal Medicine - Haematology, Charles University, Faculty of Medicine in Hradec Králové and University Hospital.
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$a Čabelková, Pavla $u Department of Radiology, Comprehensive Stroke Centre, Charles University, Faculty of Medicine in Hradec Králové and University Hospital.
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