دورية أكاديمية
Clot composition and recanalization outcomes in mechanical thrombectomy
| العنوان: | Clot composition and recanalization outcomes in mechanical thrombectomy |
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| المؤلفون: | Nogueira, Raul G, Pinheiro, Agostinho, Brinjikji, Waleed, Abbasi, Mehdi, Al-Bayati, Alhamza R, Mohammaden, Mahmoud H, Souza Viana, Lorena, Ferreira, Felipe, Abdelhamid, Hend, Bhatt, Nirav R, Kvamme, Peter, Layton, Kennith F, Delgado Almandoz, Josser E, Hanel, Ricardo A, Mendes Pereira, Vitor, Almekhlafi, Mohammed A, Yoo, Albert J, Jahromi, Babak S, Gounis, Matthew J, Patel, Biraj, Arturo Larco, Jorge L, Fitzgerald, Sean, Mereuta, Oana Madalina, Doyle, Karen, Savastano, Luis E, Cloft, Harry J, Thacker, Ike C, Kayan, Yasha, Copelan, Alexander, Aghaebrahim, Amin, Sauvageau, Eric, Demchuk, Andrew M, Bhuva, Parita, Soomro, Jazba, Nazari, Pouya, Cantrell, Donald Robert, Puri, Ajit S, Entwistle, John, Polley, Eric C, Frankel, Michael R, Kallmes, David F, Haussen, Diogo C |
| المساهمون: | Radiology |
| المصدر: | Journal of neurointerventional surgery ; England |
| سنة النشر: | 2023 |
| المجموعة: | University of Massachusetts, Medical School: eScholarship@UMMS |
| مصطلحات موضوعية: | Device, Stroke, Thrombectomy |
| الوصف: | Background: Mechanical thrombectomy (MT) has become standard for large vessel occlusions, but rates of complete recanalization are suboptimal. Previous reports correlated radiographic signs with clot composition and a better response to specific techniques. Therefore, understanding clot composition may allow improved outcomes. Methods: Clinical, imaging, and clot data from patients enrolled in the STRIP Registry from September 2016 to September 2020 were analyzed. Samples were fixed in 10% phosphate-buffered formalin and stained with hematoxylin-eosin and Martius Scarlett Blue. Percent composition, richness, and gross appearance were evaluated. Outcome measures included the rate of first-pass effect (FPE, modified Thrombolysis in Cerebral Infarction 2c/3) and the number of passes. Results: A total of 1430 patients of mean±SD age 68.4±13.5 years (median (IQR) baseline National Institutes of Health Stroke Scale score 17.2 (10.5-23), IV-tPA use 36%, stent-retrievers (SR) 27%, contact aspiration (CA) 27%, combined SR+CA 43%) were included. The median (IQR) number of passes was 1 (1-2). FPE was achieved in 39.3% of the cases. There was no association between percent histological composition or clot richness and FPE in the overall population. However, the combined technique resulted in lower FPE rates for red blood cell (RBC)-rich (P<0.0001), platelet-rich (P=0.003), and mixed (P<0.0001) clots. Fibrin-rich and platelet-rich clots required a higher number of passes than RBC-rich and mixed clots (median 2 and 1.5 vs 1, respectively; P=0.02). CA showed a trend towards a higher number of passes with fibrin-rich clots (2 vs 1; P=0.12). By gross appearance, mixed/heterogeneous clots had lower FPE rates than red and white clots. Conclusions: Despite the lack of correlation between clot histology and FPE, our study adds to the growing evidence supporting the notion that clot composition influences recanalization treatment strategy outcomes. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| تدمد: | 1759-8486 |
| العلاقة: | Journal of NeuroInterventional Surgery; https://doi.org/10.1136/jnis-2023-020117Test; Nogueira RG, Pinheiro A, Brinjikji W, Abbasi M, Al-Bayati AR, Mohammaden MH, Souza Viana L, Ferreira F, Abdelhamid H, Bhatt NR, Kvamme P, Layton KF, Delgado Almandoz JE, Hanel RA, Mendes Pereira V, Almekhlafi MA, Yoo AJ, Jahromi BS, Gounis MJ, Patel B, Arturo Larco JL, Fitzgerald S, Mereuta OM, Doyle K, Savastano LE, Cloft HJ, Thacker IC, Kayan Y, Copelan A, Aghaebrahim A, Sauvageau E, Demchuk AM, Bhuva P, Soomro J, Nazari P, Cantrell DR, Puri AS, Entwistle J, Polley EC, Frankel MR, Kallmes DF, Haussen DC. Clot composition and recanalization outcomes in mechanical thrombectomy. J Neurointerv Surg. 2023 Jul 7:jnis-2023-020117. doi:10.1136/jnis-2023-020117. Epub ahead of print. PMID: 37419694.; http://hdl.handle.net/20.500.14038/52447Test |
| DOI: | 10.1136/jnis-2023-020117 |
| الإتاحة: | https://doi.org/10.1136/jnis-2023-020117Test https://doi.org/20.500.14038/52447Test https://hdl.handle.net/20.500.14038/52447Test |
| حقوق: | © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ. |
| رقم الانضمام: | edsbas.92D79FF |
| قاعدة البيانات: | BASE |
| تدمد: | 17598486 |
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| DOI: | 10.1136/jnis-2023-020117 |