TY - JOUR
T1 - Histological evaluation of acute ischemic stroke thrombi may indicate the occurrence of vessel wall injury during mechanical thrombectomy
AU - Mereuta, Oana Madalina
AU - Abbasi, Mehdi
AU - Fitzgerald, Seán
AU - Dai, Daying
AU - Kadirvel, Ram
AU - Hanel, Ricardo A.
AU - Yoo, Albert J.
AU - Almekhlafi, Mohammed A.
AU - Layton, Kennith F.
AU - Delgado Almandoz, Josser E.
AU - Kvamme, Peter
AU - Mendes Pereira, Vitor
AU - Jahromi, Babak S.
AU - Nogueira, Raul G.
AU - Gounis, Matthew J.
AU - Patel, Biraj
AU - Aghaebrahim, Amin
AU - Sauvageau, Eric
AU - Bhuva, Parita
AU - Soomro, Jazba
AU - Demchuk, Andrew M.
AU - Thacker, Ike C.
AU - Kayan, Yasha
AU - Copelan, Alexander
AU - Nazari, Pouya
AU - Cantrell, Donald Robert
AU - Haussen, Diogo C.
AU - Al-Bayati, Alhamza R.
AU - Mohammaden, Mahmoud
AU - Pisani, Leonardo
AU - Rodrigues, Gabriel Martins
AU - Puri, Ajit S.
AU - Entwistle, John
AU - Meves, Alexander
AU - Arturo Larco, Jorge L.
AU - Savastano, Luis
AU - Cloft, Harry J.
AU - Kallmes, David F.
AU - Doyle, Karen M.
AU - Brinjikji, Waleed
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021
Y1 - 2021
N2 - Background: Several animal studies have demonstrated that mechanical thrombectomy (MT) for acute ischemic stroke (AIS) may cause vessel wall injury (VWI). However, the histological changes in human cerebral arteries following MT are difficult to determine. Objective: To investigate the occurrence of VWI during MT by histological and immunohistochemical evaluation of AIS clots. Methods: As part of the multicenter STRIP registry, 277 clots from 237 patients were analyzed using Martius Scarlett Blue stain and immunohistochemistry for CD34 (endothelial cells) and smooth muscle actin (smooth muscle cells). Results: MT devices used were aspiration catheters (100 cases), stentriever (101 cases), and both (36 cases). VWI was found in 33/277 clots (12%). There was no significant correlation between VWI and MT device. The degree of damage varied from grade I (mild intimal damage, 24 clots), to grade II (relevant intimal and subintimal damage, 3 clots), and III (severe injury, 6 clots). VWI clots contained significantly more erythrocytes (p=0.006∗) and less platelets/other (p=0.005∗) than non-VWI clots suggesting soft thrombus material. Thrombolysis correlated with a lower rate of VWI (p=0.04∗). VWI cases showed a significantly higher number of passes (2 [1-4] vs 1 [1-3], p=0.028∗) and poorer recanalization outcome (p=0.01∗) than cases without VWI. Conclusions: Histological markers of VWI were present in 12% of AIS thrombi, suggesting that VWI might be related to MT. VWI was associated with soft thrombus consistency, higher number of passes and poorer revascularization outcome. There was no significant correlation between VWI and MT device.
AB - Background: Several animal studies have demonstrated that mechanical thrombectomy (MT) for acute ischemic stroke (AIS) may cause vessel wall injury (VWI). However, the histological changes in human cerebral arteries following MT are difficult to determine. Objective: To investigate the occurrence of VWI during MT by histological and immunohistochemical evaluation of AIS clots. Methods: As part of the multicenter STRIP registry, 277 clots from 237 patients were analyzed using Martius Scarlett Blue stain and immunohistochemistry for CD34 (endothelial cells) and smooth muscle actin (smooth muscle cells). Results: MT devices used were aspiration catheters (100 cases), stentriever (101 cases), and both (36 cases). VWI was found in 33/277 clots (12%). There was no significant correlation between VWI and MT device. The degree of damage varied from grade I (mild intimal damage, 24 clots), to grade II (relevant intimal and subintimal damage, 3 clots), and III (severe injury, 6 clots). VWI clots contained significantly more erythrocytes (p=0.006∗) and less platelets/other (p=0.005∗) than non-VWI clots suggesting soft thrombus material. Thrombolysis correlated with a lower rate of VWI (p=0.04∗). VWI cases showed a significantly higher number of passes (2 [1-4] vs 1 [1-3], p=0.028∗) and poorer recanalization outcome (p=0.01∗) than cases without VWI. Conclusions: Histological markers of VWI were present in 12% of AIS thrombi, suggesting that VWI might be related to MT. VWI was associated with soft thrombus consistency, higher number of passes and poorer revascularization outcome. There was no significant correlation between VWI and MT device.
KW - stroke
KW - thrombectomy
KW - vessel wall
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U2 - 10.1136/neurintsurg-2021-017310
DO - 10.1136/neurintsurg-2021-017310
M3 - Article
C2 - 33975922
AN - SCOPUS:85106049790
SN - 1759-8478
JO - Journal of neurointerventional surgery
JF - Journal of neurointerventional surgery
ER -