Brain Circulation

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 8  |  Issue : 2  |  Page : 87--93

Impact of histological clot composition on preprocedure imaging and mechanical thrombectomy


Jeremiah N Johnson1, Aditya Srivatsan1, Juyu Chueh2, Rose Arslanian2, Matthew J Gounis2, Ajit S Puri2, Visish M Srinivasan1, Stephen Russell Chen3, Jan-Karl Burkhardt1, Peter Kan1 
1 Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
2 Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
3 Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX, USA

Correspondence Address:
Jeremiah N Johnson
Department of Neurosurgery, University of California Los Angeles, 300 Stein Plaza 420, Los Angeles, CA 90095
USA

INTRODUCTION: We studied the relationship of acute ischemic stroke (AIS) large-vessel occlusion clot composition with vessel recanalization and preprocedure imaging. SUBJECTS AND METHODS: Individual clots from AIS patients who underwent mechanical thrombectomy (MT) between September 2016 and September 2018 were examined. Clot composition was analyzed histologically through a trichrome staining and image segmentation, and the area occupied by red blood cells (RBCs), fibrin, or mixed composition was quantified. RESULTS: Forty-three patients (65.4 ± 12.7 years, 39% of females) who underwent 92 retrieval passes (mean 2.14, range 1–6) were included in this study. Fibrin (44%) occupied the greatest area, followed by mixed composition (34%) and RBCs (22%). A stent retriever was deployed in 81% of cases, 20 patients (47%) achieved first-pass efficacy (FPE) (thrombolysis in cerebral infarction [TICI] 2b-3 after first pass), 41 (95%) achieved successful revascularization (TICI 2b-3), and 21 (49%) had good outcome (modified Rankin Scale [mRS] ≤2) at 90 days. Hyperdense artery sign (HAS) on initial computed tomography was correlated with mixed clot composition (P = 0.01) and lack of fibrin content (P = 0.03). In the univariate analysis, FPE was associated with RBC clot area, atrial fibrillation, and occlusion location but not with fibrin clot area, mixed clot area, stroke etiology, thrombectomy technique, distal emboli, or 90-day mRS. In the multivariate analysis, FPE was significantly correlated with low RBC clot area (odd ratio = 0.96, confidence interval [0.92.99], P = 0.034) but not with atrial fibrillation or location. CONCLUSION: Our results suggest that HAS is correlated with mixed clot composition and lower fibrin content and that lower RBC clot composition is associated with FPE in patients undergoing MT.


How to cite this article:
Johnson JN, Srivatsan A, Chueh J, Arslanian R, Gounis MJ, Puri AS, Srinivasan VM, Chen SR, Burkhardt JK, Kan P. Impact of histological clot composition on preprocedure imaging and mechanical thrombectomy.Brain Circ 2022;8:87-93


How to cite this URL:
Johnson JN, Srivatsan A, Chueh J, Arslanian R, Gounis MJ, Puri AS, Srinivasan VM, Chen SR, Burkhardt JK, Kan P. Impact of histological clot composition on preprocedure imaging and mechanical thrombectomy. Brain Circ [serial online] 2022 [cited 2022 Aug 15 ];8:87-93
Available from: http://www.braincirculation.org/article.asp?issn=2394-8108;year=2022;volume=8;issue=2;spage=87;epage=93;aulast=Johnson;type=0