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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 2024; 16:466-470. [PMID: 37419694 DOI: 10.1136/jnis-2023-020117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/24/2023] [Indexed: 07/09/2023]
Abstract
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.
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Affiliation(s)
| | | | | | - Mehdi Abbasi
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | | | | | - Nirav R Bhatt
- UPMC Stroke Institute, Pittsburgh, Pennsylvania, USA
| | - Peter Kvamme
- Radiology, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Kennith F Layton
- NeuroInterventional Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | | | - Ricardo A Hanel
- Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network - Toronto Western Hospital, Toronto, Ontario, Canada
| | - Mohammed A Almekhlafi
- Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Albert J Yoo
- Neurointervention, Texas Stroke Institute, Plano, Texas, USA
| | - Babak S Jahromi
- Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew J Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Biraj Patel
- Radiology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
- Radiology, Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | | | | | - Oana Madalina Mereuta
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
- CÚRAM-SFI Research Centre for Medical Devices and Physiology Department, National University of Ireland Galway, Galway, Ireland
| | - Karen Doyle
- Physiology, CURAM, National University of Ireland Galway, Galway, Ireland
| | | | | | - Ike C Thacker
- NeuroInterventional Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Yasha Kayan
- Interventional Neuroradiology, Abbot Northwestern Hospital, 55435, Minnesota, USA
| | - Alexander Copelan
- NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Amin Aghaebrahim
- Lyerly Neurosurgery, Baptist Health System, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Andrew M Demchuk
- Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Parita Bhuva
- Neuroendovascular Surgery, Texas Stroke Institute, Plano, Texas, USA
| | - Jazba Soomro
- Neurointervention, Texas Stroke Institute, Plano, Texas, USA
| | - Pouya Nazari
- Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Neurosurgery and Radiology, Northwestern University, Chicago, Illinois, USA
| | | | - Ajit S Puri
- Radiology, University of Massachusetts, Worcester, Massachusetts, USA
| | - John Entwistle
- Radiology, Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | | | - Michael R Frankel
- Department of Neurology, Emory University Atlanta, Atlanta, Georgia, USA
- Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA
| | | | - Diogo C Haussen
- Neurology and Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Reymond P, Roussinova E, Brina O, Hofmeister J, Bernava G, Rosi A, Galand W, Lovblad KO, Pereira VM, Bouri M, Machi P. Can micro-guidewire advancement forces predict clot consistency and location to assist the first-line technique for mechanical thrombectomy? J Neurointerv Surg 2024:jnis-2024-021477. [PMID: 38637149 DOI: 10.1136/jnis-2024-021477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The identification of specific clot characteristics before mechanical thrombectomy (MTB) might allow the selection of the most effective first-line technique, thus potentially improving the procedural outcome. We aimed to evaluate if the microwire push forces could extrapolate information on clot consistency and extension before MTB, based on clot mechanical properties. METHODS We measured in vitro the forces exerted on the proximal extremity of the guidewire during the advancement and retrieval of the guidewire through clot analogs of different compositions. In addition, we analyzed the forces exerted on the guidewire to extrapolate information about the location of the proximal and distal extremities of the clot analogs. RESULTS The maximum forces recorded during the whole penetration phase were significantly different for hard and soft clots (median values, 55.6 mN vs 15.4 mN, respectively; P<0.0001). The maximum slope of the force curves recorded during the advancement of the guidewire for the first 3 s of penetration also significantly differentiated soft from hard clot analogs (7.6 mN/s vs 23.9 mN/s, respectively; P<0.0001). In addition, the qualitative analysis of the shape of the force curves obtained during the advancement and retrieval of the guidewire showed a good potential for the identification of the proximal and distal edges of the clot analogs. CONCLUSION Our results demonstrated that it was possible to differentiate between soft and hard clot analogs. Furthermore, force measurements could give important information about the location of the clot extremities. Such an approach might support the selection of the first-line MTB technique, with the potential to improve the outcome.
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Affiliation(s)
- Philippe Reymond
- Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Evgenia Roussinova
- Translational Neural Engineering Lab (TNE), Swiss Federal Institute of Technology Lausanne, Lausanne, Switzerland
| | - Olivier Brina
- Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland
| | | | | | - Andrea Rosi
- Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland
| | - William Galand
- Biorobotics Laboratory (BioRob), Swiss Federal Institute of Technology Lausanne, EPFL, Lausanne, Switzerland
| | | | - Vitor M Pereira
- Department of Neurosurgery, Unity Health Toronto, Toronto, Ontario, Canada
| | - Mohamed Bouri
- Translational Neural Engineering Lab (TNE), Swiss Federal Institute of Technology Lausanne, Lausanne, Switzerland
- Biorobotics Laboratory (BioRob), Swiss Federal Institute of Technology Lausanne, EPFL, Lausanne, Switzerland
| | - Paolo Machi
- Neuroradiology, University Hospitals of Geneva, Geneva, Switzerland
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3
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Xie T, Tang WW. Could emergency admission plasma D-dimer level predict first pass effect of stent retriever thrombectomy in acute ischemic stroke? Acta Radiol 2024; 65:367-373. [PMID: 38111236 DOI: 10.1177/02841851231218375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
BACKGROUND Evidence on plasma biomarkers to identify first pass effect (FPE) in patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) treated with thrombectomy is limited. PURPOSE To evaluate whether plasma D-dimer could predict FPE. MATERIAL AND METHODS Consecutive patients with LVO who underwent first-line stent retriever thrombectomy at our center between January 2018 and August 2021 were enrolled. Patients were classified into the FPE (modified Thrombolysis in Cerebral Infarction [mTICI] ≥2c) group or non-FPE (mTICI 0-2b) group based on angiographic outcomes. Logistic regression analysis was performed to determine the predictors of FPE. The overall ability of D-dimer levels in predicting FPE was evaluated using receiver operating characteristic (ROC) curves. RESULTS In total, 313 patients were included; 88 (28.1%) patients achieved FPE. Compared to those with non-FPE, patients with FPE had more diabetes mellitus history, lower D-dimer levels, higher clot burden score, a higher proportion of M1 middle cerebral artery, and a higher proportion of main stem occlusion pattern (P <0.05). After adjusting for potential variables, D-dimer levels (OR=0.81, 95% CI=0.52-0.96), clot burden score (OR=1.76, 95% CI=1.38-2.87), and main stem occlusion pattern (OR=1.85, 95% CI=1.19-2.62) remained independently associated with FPE. Based on the ROC analysis, the D-dimer as a predictor for predicting FPE presented with a specificity of 79%, a negative predictive value of 87%, and an area under the curve of 0.761. CONCLUSION Low emergency admission plasma D-dimer level is an independent predictor of FPE in patients with AIS treated with stent retriever thrombectomy.
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Affiliation(s)
- Ting Xie
- Department of Radiology, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu, PR China
| | - Wen-Wei Tang
- Department of Radiology, Nanjing Women and Children's Healthcare Hospital, Nanjing, Jiangsu, PR China
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Bertalan G, Duparc R, Krepuska M, Toth D, Madjidyar J, Thurner P, Schubert T, Kulcsar Z. Dynamic Perviousness Predicts Revascularization Success in Acute Ischemic Stroke. Diagnostics (Basel) 2024; 14:535. [PMID: 38473007 DOI: 10.3390/diagnostics14050535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The predictive value of thrombus perviousness in acute ischemic stroke (AIS), as measured by computed tomography (CT), has been intensively studied with conflicting results. In this study, we investigate the predictive potential of the novel concept of dynamic perviousness using three-dimensional (3D) volumetric evaluation of occlusive thrombi. METHODS The full thrombus volume in 65 patients with a hyperdense artery sign on non-contrast CT (NCCT), who underwent mechanical thrombectomy (MT), was segmented. Perviousness maps were computed voxel-wise for the entire thrombus volume as thrombus attenuation increase (TAI) between NCCT and CT angiography (CTA) as well as between CTA and late venous phase CT (CTV). Perviousness was analyzed for its association with NIHSS at admission, Thrombolysis In Cerebral Infarction (TICI) score, and number of MT passes. RESULTS The mean late-uptake TAI of thrombi with NIHSS scores greater than 21 at admission was approximately 100% higher than for lower scored NIHSS (p between 0.05 and 0.005). Concerning revascularization results, thrombi requiring less than four MT passes had ca. 80% higher group mean late-uptake TAI than clots requiring four or more passes (p = 0.03), and thrombi with TICI score III had ca. 95% higher group mean late-uptake TAI than thrombi with TICI II (p = 0.03). Standard perviousness showed no significant correlation with MT results. CONCLUSION Standard thrombus perviousness of 3D clot volume is not associated with revascularization results in AIS. In contrast, dynamic perviousness assessed with a voxel-wise characterization of 3D thrombi volume may be a better predictor of MT outcomes than standard perviousness.
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Affiliation(s)
- Gergely Bertalan
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
| | - Roxane Duparc
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
| | - Miklos Krepuska
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
| | - Daniel Toth
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
| | - Jawid Madjidyar
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
| | - Patrick Thurner
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
| | - Tilman Schubert
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
| | - Zsolt Kulcsar
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091 Zürich, Switzerland
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Charbonnier G, Primikiris P, Desmarets M, Tio G, Vancheri S, Di Caterino F, Vitale G, Biondi A. Defining the optimal size of an aspiration catheter in relation to the arterial diameter during mechanical thrombectomy for stroke. J Neuroradiol 2024; 51:47-51. [PMID: 36738989 DOI: 10.1016/j.neurad.2023.01.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mechanical thrombectomy for acute ischemic stroke is effective and includes different technical approaches. Operators use direct aspiration, a stent retriever, or a combination of both. Direct aspiration can be performed with various catheters of different sizes depending on the diameter of the occluded vessel. PURPOSE We studied the relationship between the catheter diameter in regards to the occluded vessel diameter and the rate of successful recanalization. MATERIALS AND METHODS We conducted a retrospective, monocentric study on a series of consecutive patients treated with mechanical thrombectomy. For each procedure, we extracted each attempt that used direct aspiration and rated the attempt as successful or unsuccessful. We also measured the occluded artery diameter and calculated the ratio between the occluded artery and the aspiration catheter diameters. We tested the association between the diameter ratio and the recanalization status. We also performed inter-rater agreement for the arterial diameter measurement between three interventional neuroradiologists. RESULTS We included 119 patients with 201 attempts of direct aspiration. A higher diameter ratio was associated with a higher recanalization rate. The analysis in terciles showed that the odds of success were 4.80 higher when the ratio was >0.71 vs <0.54 (p < 0.01). Inter-rater agreement showed near-perfect intraclass correlation with 0.93 (0.91-0.94) consistency and 0.92 (0.90-0.94) absolute agreement. CONCLUSIONS We demonstrated an association between higher recanalization and a diameter of ratio >0.71 between the aspiration catheter and the occluded artery. These results could guide intraoperative decisions regarding the appropriate selection of aspiration catheters during mechanical thrombectomy increasing the rate of successful recanalisation. A larger study could provide additional data to further specify the optimal ratio.
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Affiliation(s)
- Guillaume Charbonnier
- Department of Interventional Neuroradiology, Besançon University Hospital, Besançon, France; Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive - UR 481, Université de Franche-Comté, Besançon, France.
| | - Panagiotis Primikiris
- Department of Interventional Neuroradiology, Besançon University Hospital, Besançon, France
| | - Maxime Desmarets
- Inserm CIC 1431, CHU Besançon, Unité de méthodologie, Besançon, France; UMR 1098 Right, Inserm, Établissement Français du Sang, Université Bourgogne-Franche-Comté, Besançon, France
| | - Gregory Tio
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive - UR 481, Université de Franche-Comté, Besançon, France; Inserm CIC 1431, CHU Besançon, Unité de méthodologie, Besançon, France
| | - Sergio Vancheri
- Department of Interventional Neuroradiology, Besançon University Hospital, Besançon, France
| | - Fortunato Di Caterino
- Department of Interventional Neuroradiology, Besançon University Hospital, Besançon, France
| | - Giovanni Vitale
- Department of Interventional Neuroradiology, Besançon University Hospital, Besançon, France
| | - Alessandra Biondi
- Department of Interventional Neuroradiology, Besançon University Hospital, Besançon, France; Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive - UR 481, Université de Franche-Comté, Besançon, France
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Kamepalli HK, Kannath SK, Sylaja PN, Rajan JE, Chandrasekharan K. Thrombus Attenuation Gradient Can Predict Successful First-Pass Recanalization Following Stentriever Thrombectomy. World Neurosurg 2024; 181:e780-e788. [PMID: 37925151 DOI: 10.1016/j.wneu.2023.10.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE Computed tomography angiography (CTA) derived thrombus enhancement characteristics can predict first-pass recanalization. We studied whether dynamic contrast kinetics within the clot in multiphase CTA can predict first-pass recanalization following stentriever thrombectomy. METHODS Patients with acute large vessel occlusive stroke evaluated with multiphasic CTA who underwent stentriever thrombectomy were selected. Thrombus perviousness on various phases including arterial, venous, and delayed phases was calculated. Thrombus attenuation gradient (TAG), defined as average attenuation difference between adjacent phases, was also evaluated and correlated with successful first-pass outcome (modified Treatment in Cerebral Ischemia score ≥2b). RESULTS Of 69 patients, 32 (47%) had successful first-pass recanalization (group 1), and 37 (53%) required >1 attempt (group 2). TAG showed significant differences in arterial-plain and venous-arterial phases. The early increase in TAG was seen in group 1 in the arterial-plain phase, as opposed to group 2 (12.6 vs. 9, P = 0.01), which plateaued in the venous-arterial phase for group 1 and showed a further increase in group 2 (2.1 vs. 5.1, P = 0.02). A cutoff value of 9.2 HU for arterial-plain phase (P = 0.001) and 4.2 HU (P = 0.001) for venous-arterial phase was predictive of first-pass effect. Combining 2 metrics had an odds ratio of 2.8 for first-pass recanalization (P = 0.035). Accuracy evaluated in a validation cohort yielded 74%. Other features including histology were not significant. CONCLUSIONS TAG evaluated from multiphase CTA can predict first-pass effect in stentriever thrombectomy.
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Affiliation(s)
- Hari Kishore Kamepalli
- Neurointervention Center, Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Santhosh Kumar Kannath
- Neurointervention Center, Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
| | - P N Sylaja
- Neurointervention Center, Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Jayadevan Enakshy Rajan
- Neurointervention Center, Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Kesavadas Chandrasekharan
- Neurointervention Center, Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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7
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Schartz D, Akkipeddi SMK, Rahmani R, Ellens N, Houk C, Kohli GS, Worley L, Welle K, Bhalla T, Mattingly T, Morrell C, Bender MT. Ischemic Stroke Thrombus Perviousness Is Associated with Distinguishable Proteomic Features and Susceptibility to ADAMTS13-Augmented Thrombolysis. AJNR Am J Neuroradiol 2023; 45:22-29. [PMID: 38123915 PMCID: PMC10756583 DOI: 10.3174/ajnr.a8069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/20/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND PURPOSE Perviousness is the differential attenuation on CT of an intracranial arterial occlusive thrombus before and after IV contrast administration. While perviousness/permeability has been shown to be related to various clinical outcomes and reflects histopathologic composition, it remains unclear whether perviousness is also associated with differences in proteomic composition. MATERIALS AND METHODS Retrieved clots from 59 patients were evaluated with quantitative mass spectrometry. Proteomic differences between high-perviousness (≥11 HU) and low-perviousness (<11 HU) clots were investigated. Perviousness as a continuous variable was also correlated with protein abundance. Last, an ex vivo lysis assay was performed to investigate the differential susceptibility to tPA, deoxyribonuclease, and ADAMTS13 thrombolysis as a function of perviousness. RESULTS In total, 2790 distinct proteins were identified. Thrombus perviousness was associated with distinct proteomic features, including depletion of the macrophage marker CD14 (P = .039, z = 1.176) and hemoglobin subunit ζ (P = .046, z = 1.68) in pervious clots. Additionally, proteins involved in platelet cytoskeleton remodeling (tropomyosin α-3-chain) and granule secretion/aggregation (synaptotagmin-like protein 4/FC region receptor II-a) were associated with increasing perviousness (P < .006), among numerous other proteins. Monocyte/macrophage-associated proteins (apoptosis-associated specklike protein containing a CARD/SAMHD1) were also depleted in pervious emboli (P < .002). Ex vivo lysis indicated that pervious clots were more susceptible to ADAMTS13-augmented tPA thrombolysis compared with impervious clots (P < .05), though without differences in deoxyribonuclease digestion. CONCLUSIONS Thrombus perviousness is associated with complex proteomic features, including differential abundance of platelet-related proteins in highly permeable clots with monocyte/macrophage depletion. This association may help to explain why highly pervious thrombi were also found more susceptible to ADAMTS13-augmented thrombolysis.
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Affiliation(s)
- Derrek Schartz
- From the Department of Imaging Sciences (D.S., L.W.), University of Rochester Medical Center, Rochester, New York
- Department of Neurosurgery (D.S., S.M.K.A., R.R., N.E., C.H., G.S.K., K.W., T.B., T.M., M.T.B.), University of Rochester Medical Center, Rochester, New York
| | - Sajal Medha K Akkipeddi
- Department of Neurosurgery (D.S., S.M.K.A., R.R., N.E., C.H., G.S.K., K.W., T.B., T.M., M.T.B.), University of Rochester Medical Center, Rochester, New York
| | - Redi Rahmani
- Department of Neurosurgery (D.S., S.M.K.A., R.R., N.E., C.H., G.S.K., K.W., T.B., T.M., M.T.B.), University of Rochester Medical Center, Rochester, New York
| | - Nathaniel Ellens
- Department of Neurosurgery (D.S., S.M.K.A., R.R., N.E., C.H., G.S.K., K.W., T.B., T.M., M.T.B.), University of Rochester Medical Center, Rochester, New York
| | - Clifton Houk
- Department of Neurosurgery (D.S., S.M.K.A., R.R., N.E., C.H., G.S.K., K.W., T.B., T.M., M.T.B.), University of Rochester Medical Center, Rochester, New York
| | - Gurkirat Singh Kohli
- Department of Neurosurgery (D.S., S.M.K.A., R.R., N.E., C.H., G.S.K., K.W., T.B., T.M., M.T.B.), University of Rochester Medical Center, Rochester, New York
| | - Logan Worley
- From the Department of Imaging Sciences (D.S., L.W.), University of Rochester Medical Center, Rochester, New York
| | - Kevin Welle
- Department of Neurosurgery (D.S., S.M.K.A., R.R., N.E., C.H., G.S.K., K.W., T.B., T.M., M.T.B.), University of Rochester Medical Center, Rochester, New York
| | - Tarun Bhalla
- Department of Neurosurgery (D.S., S.M.K.A., R.R., N.E., C.H., G.S.K., K.W., T.B., T.M., M.T.B.), University of Rochester Medical Center, Rochester, New York
| | - Thomas Mattingly
- Department of Neurosurgery (D.S., S.M.K.A., R.R., N.E., C.H., G.S.K., K.W., T.B., T.M., M.T.B.), University of Rochester Medical Center, Rochester, New York
| | - Craig Morrell
- Aab Cardiovascular Research Institute (C.M.), University of Rochester Medical Center, Rochester, New York
| | - Matthew T Bender
- Department of Neurosurgery (D.S., S.M.K.A., R.R., N.E., C.H., G.S.K., K.W., T.B., T.M., M.T.B.), University of Rochester Medical Center, Rochester, New York
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8
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Shang K, Zhu W, Ye L, Li Y. Effect of mechanical thrombectomy with and without intravenous thrombolysis on the functional outcome of patients with different degrees of thrombus perviousness. Neuroradiology 2023; 65:1657-1663. [PMID: 37640883 DOI: 10.1007/s00234-023-03210-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 08/06/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE This study aimed to investigate the long-term functional outcome of patients with different degrees of thrombus perviousness (TP) undergoing mechanical thrombectomy alone and those undergoing combined intravenous thrombolysis (IVT) plus mechanical thrombectomy. METHODS We conducted a retrospective analysis of consecutive patients with acute ischemic stroke due to large vessel occlusion who underwent mechanical thrombectomy alone or bridging therapy between January 2016 and October 2020. TP was quantified by thrombus attenuation increase (TAI) on admission computed tomography angiography compared with non-contrast computed tomography. After dichotomization of TAI as higher or lower perviousness, Fisher exact tests were performed to estimate the associations of different therapies with favorable functional outcomes [Modified Ranking Scale score at 90 days (90-day mRS) of 0 to 2]. RESULTS A total of 73 patients were included in our study. 35 (47.9%) thrombi were classified as higher-perviousness clots with TAI of ≥ 24 HU, and the other 38 thrombi were lower-perviousness clots. A favorable outcome with a 90-day mRS of 0 to 2 was observed in 32 patients. In patients with thrombi of lower perviousness, favorable outcome was more common in the bridging therapy group than in the thrombectomy-alone group (p = 0.013), whereas in patients with thrombi of higher perviousness, the long-term neurological outcome did not significantly differ between two therapy groups (p = 0.094). CONCLUSION Patients with thrombi of lower perviousness were recommended to undergo intravenous alteplase followed by endovascular thrombectomy, and those with thrombi of higher perviousness could undergo thrombectomy alone.
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Affiliation(s)
- Kai Shang
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600 Yishan Road, Xuhui District, Shanghai, 200235, China
| | - Wangshu Zhu
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600 Yishan Road, Xuhui District, Shanghai, 200235, China
| | - Lifang Ye
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600 Yishan Road, Xuhui District, Shanghai, 200235, China
| | - Yuehua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600 Yishan Road, Xuhui District, Shanghai, 200235, China.
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9
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Patel TR, Santo BA, Baig AA, Waqas M, Monterio A, Levy EI, Siddiqui AH, Tutino VM. Histologically interpretable clot radiomic features predict treatment outcomes of mechanical thrombectomy for ischemic stroke. Neuroradiology 2023; 65:737-749. [PMID: 36600077 DOI: 10.1007/s00234-022-03109-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Radiomics features (RFs) extracted from CT images may provide valuable information on the biological structure of ischemic stroke blood clots and mechanical thrombectomy outcome. Here, we aimed to identify RFs predictive of thrombectomy outcomes and use clot histomics to explore the biology and structure related to these RFs. METHODS We extracted 293 RFs from co-registered non-contrast CT and CTA. RFs predictive of revascularization outcomes defined by first-pass effect (FPE, near to complete clot removal in one thrombectomy pass), were selected. We then trained and cross-validated a balanced logistic regression model fivefold, to assess the RFs in outcome prediction. On a subset of cases, we performed digital histopathology on the clots and computed 227 histomic features from their whole slide images as a means to interpret the biology behind significant RF. RESULTS We identified 6 significantly-associated RFs. RFs reflective of continuity in lower intensities, scattered higher intensities, and intensities with abrupt changes in texture were associated with successful revascularization outcome. For FPE prediction, the multi-variate model had high performance, with AUC = 0.832 ± 0.031 and accuracy = 0.760 ± 0.059 in training, and AUC = 0.787 ± 0.115 and accuracy = 0.787 ± 0.127 in cross-validation testing. Each of the 6 RFs was related to clot component organization in terms of red blood cell and fibrin/platelet distribution. Clots with more diversity of components, with varying sizes of red blood cells and fibrin/platelet regions in the section, were associated with RFs predictive of FPE. CONCLUSION Upon future validation in larger datasets, clot RFs on CT imaging are potential candidate markers for FPE prediction.
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Affiliation(s)
- Tatsat R Patel
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Briana A Santo
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Ammad A Baig
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Andre Monterio
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Elad I Levy
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Adnan H Siddiqui
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Vincent M Tutino
- Canon Stroke and Vascular Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14203, USA.
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY, USA.
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA.
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, NY, USA.
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA.
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10
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He G, Deng J, Lu H, Wei L, Zhao Y, Zhu Y, Li Y. Thrombus enhancement sign on CT angiography is associated with the first pass effect of stent retrievers. J Neurointerv Surg 2023; 15:146-152. [PMID: 35110399 DOI: 10.1136/neurintsurg-2021-018447] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/13/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND The thrombus enhancement sign (TES) is thought to be associated with the source of the stroke and thrombus composition. We investigated whether this imaging sign along with other thrombus characteristics could be used to predict the successful first pass effect (FPE) of mechanical thrombectomy. METHODS 246 consecutive patients with acute ischemic stroke in the anterior circulation with large vessel occlusion who underwent thrombectomy with a stent retriever and clot collection were included. Patients were divided into FPE (modified Thrombolysis in Cerebral Infarction (mTICI) grade 2c or 3)/non-FPE (mTICI 0-2b) and modified FPE (mFPE) (mTICI 2b-3)/non-mFPE (mTICI 0-2a) groups based on flow restoration after the first pass. TES presence, thrombus density, thrombus length, clot burden score, and thrombus composition were compared. The association between FPE and imaging biomarkers, along with clinical and interventional parameters, was investigated by univariate and multivariate analysis. RESULTS FPE was achieved in 85 (34.6%) patients. TES presence was significantly lower in the FPE group (64.7% vs 80.7% in the non-FPE group, p=0.008) and mFPE group (69.1% vs 81.0% in the non-mFPE group, p=0.039). Histopathological examination revealed that TES (+) thrombi contained a higher fibrin/platelet proportion (50.9% vs 46.9% in TES (-) thrombi, p=0.029) and fewer erythrocytes (43.3% vs 47.3% in TES (-) thrombi, p=0.030). Thrombus characteristics, namely shorter thrombus length (p=0.032), higher erythrocyte proportions (p=0.026), and less fibrin/platelets (p=0.014), were confirmed in patients with FPE. In multivariable analysis, TES was the only independent predictor of FPE failure (OR 0.51, 95% CI 0.28 to 0.94; p=0.031). CONCLUSIONS TES was independently associated with first pass angiographic failure in patients treated with a stent retriever.
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Affiliation(s)
- Guangchen He
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiangshan Deng
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haitao Lu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Liming Wei
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuwu Zhao
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yueqi Zhu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuehua Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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11
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Does thrombus imaging characteristics predict the degree of recanalisation after endovascular thrombectomy in acute ischaemic stroke? J Stroke Cerebrovasc Dis 2022; 31:106621. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/22/2022] Open
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12
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Abstract
The treatment of acute ischemic stroke continues to advance. The mainstay of treatment remains intravenous thrombolysis with alteplase. Recent studies demonstrated that later treatment with alteplase is beneficial in patients selected with advanced imaging techniques. Tenecteplase has been evaluated as an alternative thrombolytic drug and evidence suggests that it is as least as effective as alteplase and may lyse large vessel clots more effectively. Endovascular therapy with mechanical thrombectomy has now been shown to be beneficial up to 24 hours after stroke onset in carefully selected patients with proximal, large vessel occlusions. Ongoing studies are evaluating the effectiveness of thrombectomy in patients with more distal vessel occlusions and patients with proximal large vessel occlusions with larger ischemic core volumes and also in patients with milder neurological deficits. Cytoprotection is another potential acute stroke therapy that has not demonstrated efficacy in prior clinical trials. It should be reconsidered as an adjunct to reperfusion and a variety of new clinical trials can be envisioned to evaluate the potential benefits of cytoprotection in patients before and after reperfusion.
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Affiliation(s)
- Yunyun Xiong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.X.).,Chinese Institute of Brain Research (Y.X.)
| | - Ajay K Wakhloo
- Department of Neurointerventional Radiology Beth Israel Lahey Health Medical Center, Tufts University School of Medicine, Burlington' MA (A.K.W.)
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School' Boston' MA (M.F.)
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13
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Gao Q, Qi P, Wang J, Hu S, Yang X, Fan J, Li L, Lu Y, Lu J, Chen J, Wang D. Effects of diabetes mellitus complicated by admission hyperglycemia on clot histological composition and ultrastructure in patients with acute ischemic stroke. BMC Neurol 2022; 22:130. [PMID: 35382802 PMCID: PMC8981928 DOI: 10.1186/s12883-022-02660-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) affects the occurrence and prognosis of acute ischemic stroke (AIS). However, the impact of diabetes on thrombus characteristics is unclear. The relationship between the composition and ultrastructure of clots and DM with admission hyperglycemia was investigated. Methods Consecutive patients with AIS who underwent endovascular thrombus retrieval between June 2017 and May 2021 were recruited. The thrombus composition and ultrastructure were evaluated using Martius scarlet blue stain and scanning electron microscopy. Clot perviousness was evaluated via thrombus attenuation increase on computed tomography angiography (CTA) versus non-contrast CT. Patients with admission hyperglycemia DM (ahDM) and those without DM (nonDM) were compared in terms of thrombus composition, ultrastructure, and perviousness. Results On admission, higher NIHSS scores (17 vs. 12, respectively, p = 0.015) was evident in ahDM patients. After the 90-day follow-up, the rates of excellent outcomes (mRS 0–1) were lower in patients with ahDM (16.6%, p = 0.038), but functional independence (mRS 0–2) and handicapped (mRS 3–5) were comparable between patients with ahDM and nonDM. The outcome of mortality was higher in patients with ahDM (33.3%, p = 0.046) than in nonDM patients. Clots in patients with ahDM had more fibrin (39.4% vs. 25.0%, respectively, p = 0.007), fewer erythrocyte components (21.2% vs. 41.5%, respectively, p = 0.043), equivalent platelet fraction (27.7% vs. 24.6%, respectively, p = 0.587), and higher WBC counts (4.6% vs. 3.3%, respectively, p = 0.004) than in nonDM patients. The percentage of polyhedral erythrocytes in thrombi was significantly higher in ahDM patients than in nonDM patients (68.9% vs. 45.6%, respectively, p = 0.007). The proportion of pervious clots was higher in patients nonDM than in patients with ahDM (82.61% vs. 40%, respectively, p = 0.026). Conclusion Patients with ahDM presented with greater stroke severity on admission and poorer functional outcomes after 3 months. Clots in patients with ahDM had more fibrin, leucocytes, and fewer erythrocyte components than in patients nonDM. The content of polyhedral erythrocytes and impervious clots proportion were significantly higher in thrombi of patients with AIS and ahDM. Further research is required to validate these findings.
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Affiliation(s)
- Qun Gao
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Junjie Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Shen Hu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Ximeng Yang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China
| | - Jingwen Fan
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China.,Peking University Fifth School of Clinical Medicine, Beijing Hospital, Beijing, China
| | - Ling Li
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China.,Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Yao Lu
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China.,Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China. .,Graduate School of Peking Union Medical College, Beijing, China.
| | - Juan Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China. .,Beijing Institute of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing, China.
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No.1 DaHua Road, Dong Dan, Beijing, 100730, People's Republic of China. .,Graduate School of Peking Union Medical College, Beijing, China.
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14
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Nie C, Kang Z, Tu M, Wu X, Sun D, Mei B. Clot Meniscus Sign Is Associated With Thrombus Permeability and Choice of Mechanical Thrombectomy Technique in Acute Middle Cerebral Artery Occlusion. Front Neurol 2022; 13:850429. [PMID: 35280281 PMCID: PMC8908095 DOI: 10.3389/fneur.2022.850429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/24/2022] [Indexed: 12/30/2022] Open
Abstract
Background and PurposeThe method of mechanical thrombectomy (MT) is related to vascular anatomy and stroke etiology. Meniscus sign and thrombus permeability as imaging markers may be instructive for the selection of MT. This study aims to clarify the relationship among meniscus sign, thrombus permeability, and choice of MT in patients with acute middle cerebral artery occlusion.Materials and MethodsA total of 111 patients with acute middle cerebral artery occlusion (MCAO) who underwent MT were retrospectively analyzed. Clot meniscus sign was defined as the appearance of meniscoid/edge-like or single- or double-wall contrast channels besides or around insular blood clots. The radiographic, clinical, and surgical data of patients with MCAO with or without meniscus sign were compared.ResultsThe meniscus sign positive group (n = 26) has higher thrombus permeability (HUs) (26.92 ± 9.69 vs. 22.84 ± 7.88, p = 0.031) than those without it. Shorter puncture-to-recanalization (P2R) time (65.5 vs. 88, p = 0.012), higher complete recanalization rate (85.71 vs. 33.33%, p < 0.01), and better clinical outcome (p < 0.01) were obtained by selecting contact aspiration (CA) over stent retriever (SR) in patients with positive meniscus sign. In patients with negative meniscus sign, there was no significant difference in clinical outcome after receiving CA or SR.ConclusionPatients with MCAO with positive meniscus sign have higher thrombus permeability and are more suitable for CA to acquire better clinical outcomes.
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Affiliation(s)
- Chuang Nie
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Zhiming Kang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Mengqi Tu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Xiangbo Wu
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Dong Sun
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Bin Mei
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
- *Correspondence: Bin Mei
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15
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Belachew NF, Piechowiak EI, Dobrocky T, Meinel TR, Hakim A, Barvulsky EA, Vynckier J, Arnold M, Seiffge DJ, Wiest R, Fischer U, Gralla J, Kaesmacher J, Mordasini P. Stent-Based Retrieval Techniques in Acute Ischemic Stroke Patients with and Without Susceptibility Vessel Sign. Clin Neuroradiol 2022; 32:407-418. [PMID: 34463776 PMCID: PMC9187552 DOI: 10.1007/s00062-021-01079-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/27/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Randomized controlled trials have challenged the assumption that reperfusion success after mechanical thrombectomy varies depending on the retrieval techniques applied; however, recent analyses have suggested that acute ischemic stroke (AIS) patients showing susceptibility vessel sign (SVS) may respond differently. We aimed to compare different stent retriever (SR)-based thrombectomy techniques with respect to interventional outcome parameters depending on SVS status. METHODS We retrospectively reviewed 497 patients treated with SR-based thrombectomy for anterior circulation AIS. Imaging was conducted using a 1.5 T or 3 T magnetic resonance imaging (MRI) scanner. Logistic regression analyses were performed to test for the interaction of SVS status and first-line retrieval technique. Results are shown as percentages, total values or adjusted odds ratio (aOR) with 95% confidence intervals (CI). RESULTS An SVS was present in 87.9% (n = 437) of patients. First-line SR thrombectomy was used to treat 293 patients, whereas 204 patients were treated with a combined approach (COA) of SR and distal aspiration. An additional balloon-guide catheter (BGC) was used in 273 SR-treated (93.2%) and 89 COA-treated (43.6%) patients. On logistic regression analysis, the interaction variable of SVS status and first-line retrieval technique was not associated with first-pass reperfusion (aOR 1.736, 95% CI 0.491-6.136; p = 0.392), overall reperfusion (aOR 3.173, 95% CI 0.752-13.387; p = 0.116), periinterventional complications, embolization into new territories, or symptomatic intracerebral hemorrhage. The use of BGC did not affect the results. CONCLUSION While previous analyses indicated that first-line SR thrombectomy may promise higher rates of reperfusion than contact aspiration in AIS patients with SVS, our data show no superiority of any particular SR-based retrieval technique regardless of SVS status.
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Affiliation(s)
- Nebiyat F. Belachew
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Eike I. Piechowiak
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Tomas Dobrocky
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Thomas R. Meinel
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Arsany Hakim
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Enrique A. Barvulsky
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Jan Vynckier
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David J. Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland ,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstraße 18, 3010 Bern, Switzerland
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16
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Jang KM, Choi HH, Nam TK, Byun JS. Clinical outcomes of first-pass effect after mechanical thrombectomy for acute ischemic stroke: A systematic review and meta-analysis. Clin Neurol Neurosurg 2021; 211:107030. [PMID: 34823155 DOI: 10.1016/j.clineuro.2021.107030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/30/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The first-pass effect (FPE) during a mechanical thrombectomy for ischemic stroke results in favorable clinical outcomes and low symptomatic intracranial hemorrhage (sICH) rates according to individual observational studies. We performed an integrated study-level meta-analysis to compare the clinical outcomes and safety profiles of single (FPE group) and multiple passages (non-FPE group) of devices in patients who achieved successful recanalizations. METHODS A literature search of the PubMed, Embase, and Cochrane databases for FPE was conducted. We included studies comparing outcomes between patients with and without FPE for 90-day favorable outcome, mortality, and sICH. The results from the pooled analysis using the random-effects model were presented as odds ratios (OR) and 95% confidence intervals (CI). RESULTS Of the 8 selected studies comprising 2308 patients, the overall rates of the FPE were 40.3% (930/2308). The FPE was significantly associated with more 90-day favorable outcomes (OR: 1.31, 95% CI: 1.13-1.51) and lower mortality (OR: 0.53, 95% CI: 0.34-0.81), but there were no significant differences in sICH rates (OR: 0.80, 95% CI: 0.50-1.30). The results of the meta-regression analysis showed that there was no confounding effect of intravenous thrombolysis prior to thrombectomy. CONCLUSION Our findings indicated that patients who achieved the FPE would have more 90-day favorable outcomes and lower mortality compared with non-FPE patients. However, there was a limited association between the FPE and reduced sICH rates.
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Affiliation(s)
- Kyoung Min Jang
- Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hyun Ho Choi
- Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
| | - Taek Kyun Nam
- Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Byun
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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17
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Santos EMM, Arrarte Terreros N, Kappelhof M, Borst J, Boers AMM, Lingsma HF, Berkhemer OA, Dippel DWJ, Majoie CB, Marquering HA, Niessen WJ. Associations of thrombus perviousness derived from entire thrombus segmentation with functional outcome in patients with acute ischemic stroke. J Biomech 2021; 128:110700. [PMID: 34482225 DOI: 10.1016/j.jbiomech.2021.110700] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/29/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
Thrombus perviousness is strongly associated with functional outcome and intravenous alteplase treatment success in patients with acute ischemic stroke. Accuracy of thrombus attenuation increase (TAI) assessment may be compromised by a heterogeneous thrombus composition and interobserver variations of currently used manual measurements. We hypothesized that TAI is more strongly associated with clinical outcomes when evaluated on the entire thrombus. In 195 patients, five TAI measures were performed: one manual by placing three regions of interest (TAImanual) and four automated ones assessing densities from the entire thrombus. The automated TAI measures were calculated by comparing quartiles; Q1, Q2, and Q3 of the non-contrast and contrast enhanced thrombus density distribution and using the lag of the maximum of the cross correlations (MCC). Associations with functional outcome (mRS at 90 days) were assessed with univariate and multivariable analyses. All entire TAI measures were significantly associated with functional outcome with odd ratios (OR) of 1.63(95 %CI:1.19-2.25, p = 0.003) for Q1, 1.56(95 %CI:1.16-2.10, p = 0.003) for Q2, 1.24(95 %CI:1.00-1.54, p = 0.045) for Q3, and 1.70(95 %CI:1.24-2.34, p = 0.001) for MCC per 10 HU increase in univariate models. TAImanual was not significantly associated with functional outcome (p = 0.055). In the multivariable logistic regression models including age, NIHSS, and recanalization, only TAI measures derived from the entire thrombus were independently associated with favorable outcome; OR of 1.64(95 %CI:1.01-2.66, p = 0.048) for Q2 and 1.82(1.13-2.95, p = 0.014) for MCC per 10 HU increase of thrombus attenuation. The novel perviousness measures of the entire thrombus are more strongly associated with functional outcome than the traditional manual perviousness assessments.
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Affiliation(s)
- Emilie M M Santos
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Department of Biomedical Engineering and Physics, Amsterdam UMC, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Universtiy Medical Center, Rotterdam, the Netherlands; Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nerea Arrarte Terreros
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Department of Biomedical Engineering and Physics, Amsterdam UMC, Amsterdam, the Netherlands
| | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jordi Borst
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anna M M Boers
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Institute of Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Olvert A Berkhemer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Universtiy Medical Center, Rotterdam, the Netherlands; Department of Neurology, Erasmus Universtiy Medical Center, Rotterdam, the Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus Universtiy Medical Center, Rotterdam, the Netherlands
| | - Charles B Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Henk A Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Department of Biomedical Engineering and Physics, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Wiro J Niessen
- Department of Radiology and Nuclear Medicine, Erasmus Universtiy Medical Center, Rotterdam, the Netherlands; Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands
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18
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Patel TR, Waqas M, Sarayi SMMJ, Ren Z, Borlongan CV, Dossani R, Levy EI, Siddiqui AH, Snyder KV, Davies JM, Mokin M, Tutino VM. Revascularization Outcome Prediction for A Direct Aspiration-First Pass Technique (ADAPT) from Pre-Treatment Imaging and Machine Learning. Brain Sci 2021; 11:brainsci11101321. [PMID: 34679386 PMCID: PMC8534082 DOI: 10.3390/brainsci11101321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/16/2021] [Accepted: 10/02/2021] [Indexed: 01/14/2023] Open
Abstract
A direct aspiration-first pass technique (ADAPT) has recently gained popularity for the treatment of large vessel ischemic stroke. Here, we sought to create a machine learning-based model that uses pre-treatment imaging metrics to predict successful outcomes for ADAPT in middle cerebral artery (MCA) stroke cases. In 119 MCA strokes treated by ADAPT, we calculated four imaging parameters-clot length, perviousness, distance from the internal carotid artery (ICA) and angle of interaction (AOI) between clot/catheter. We determined treatment success by first pass effect (FPE), and performed univariate analyses. We further built and validated multivariate machine learning models in a random train-test split (75%:25%) of our data. To test model stability, we repeated the machine learning procedure over 100 randomizations, and reported the average performances. Our results show that perviousness (p = 0.002) and AOI (p = 0.031) were significantly higher and clot length (p = 0.007) was significantly lower in ADAPT cases with FPE. A logistic regression model achieved the highest accuracy (74.2%) in the testing cohort, with an AUC = 0.769. The models had similar performance over the 100 train-test randomizations (average testing AUC = 0.768 ± 0.026). This study provides feasibility of multivariate imaging-based predictors for stroke treatment outcome. Such models may help operators select the most adequate thrombectomy approach.
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Affiliation(s)
- Tatsat R. Patel
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY 14228, USA
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14203, USA
| | - Seyyed M. M. J. Sarayi
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY 14228, USA
| | - Zeguang Ren
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL 33613, USA; (Z.R.); (C.V.B.); (M.M.)
| | - Cesario V. Borlongan
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL 33613, USA; (Z.R.); (C.V.B.); (M.M.)
| | - Rimal Dossani
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14203, USA
| | - Elad I. Levy
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14203, USA
| | - Adnan H. Siddiqui
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14203, USA
| | - Kenneth V. Snyder
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14203, USA
| | - Jason M. Davies
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14203, USA
| | - Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL 33613, USA; (Z.R.); (C.V.B.); (M.M.)
| | - Vincent M. Tutino
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA; (T.R.P.); (M.W.); (S.M.M.J.S.); (R.D.); (E.I.L.); (A.H.S.); (K.V.S.); (J.M.D.)
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY 14228, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14203, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, NY 14203, USA
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14228, USA
- Correspondence: ; Tel./Fax: +1-(716)-829-5400
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19
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Benson JC, Kallmes DF, Larson AS, Brinjikji W. Radiology-Pathology Correlations of Intracranial Clots: Current Theories, Clinical Applications, and Future Directions. AJNR Am J Neuroradiol 2021; 42:1558-1565. [PMID: 34301640 DOI: 10.3174/ajnr.a7249] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/06/2021] [Indexed: 11/07/2022]
Abstract
In recent years, there has been substantial progression in the field of stroke clot/thrombus imaging. Thrombus imaging aims to deduce the histologic composition of the clot through evaluation of various imaging characteristics. If the histology of a thrombus can be reliably determined by noninvasive imaging methods, critical information may be extrapolated about its expected response to treatment and about the patient's clinical outcome. Crucially, as we move into an era of stroke therapy individualization, determination of the histologic composition of a clot may be able to guide precise and targeted therapeutic effort. Most radiologists, however, remain largely unfamiliar with the topic of clot imaging. This article will review the current literature regarding clot imaging, including its histologic backdrop, the correlation of images with cellular components and treatment responsiveness, and future expectations.
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Affiliation(s)
- J C Benson
- From the Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota
| | - D F Kallmes
- From the Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota
| | - A S Larson
- From the Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota
| | - W Brinjikji
- From the Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota
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20
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Kappelhof M, Tolhuisen ML, Treurniet KM, Dutra BG, Alves H, Zhang G, Brown S, Muir KW, Dávalos A, Roos YBWEM, Saver JL, Demchuk AM, Jovin TG, Bracard S, Campbell BCV, van der Lugt A, Guillemin F, White P, Hill MD, Dippel DWJ, Mitchell PJ, Goyal M, Marquering HA, Majoie CBLM. Endovascular Treatment Effect Diminishes With Increasing Thrombus Perviousness: Pooled Data From 7 Trials on Acute Ischemic Stroke. Stroke 2021; 52:3633-3641. [PMID: 34281377 PMCID: PMC8547583 DOI: 10.1161/strokeaha.120.033124] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: Thrombus perviousness estimates residual flow along a thrombus in acute ischemic stroke, based on radiological images, and may influence the benefit of endovascular treatment for acute ischemic stroke. We aimed to investigate potential endovascular treatment (EVT) effect modification by thrombus perviousness. Methods: We included 443 patients with thin-slice imaging available, out of 1766 patients from the pooled HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke trials) data set of 7 randomized trials on EVT in the early window (most within 8 hours). Control arm patients (n=233) received intravenous alteplase if eligible (212/233; 91%). Intervention arm patients (n=210) received additional EVT (prior alteplase in 178/210; 85%). Perviousness was quantified by thrombus attenuation increase on admission computed tomography angiography compared with noncontrast computed tomography. Multivariable regression analyses were performed including multiplicative interaction terms between thrombus attenuation increase and treatment allocation. In case of significant interaction, subgroup analyses by treatment arm were performed. Our primary outcome was 90-day functional outcome (modified Rankin Scale score), resulting in an adjusted common odds ratio for a one-step shift towards improved outcome. Secondary outcomes were mortality, successful reperfusion (extended Thrombolysis in Cerebral Infarction score, 2B–3), and follow-up infarct volume (in mL). Results: Increased perviousness was associated with improved functional outcome. After adding a multiplicative term of thrombus attenuation increase and treatment allocation, model fit improved significantly (P=0.03), indicating interaction between perviousness and EVT benefit. Control arm patients showed significantly better outcomes with increased perviousness (adjusted common odds ratio, 1.2 [95% CI, 1.1–1.3]). In the EVT arm, no significant association was found (adjusted common odds ratio, 1.0 [95% CI, 0.9–1.1]), and perviousness was not significantly associated with successful reperfusion. Follow-up infarct volume (12% [95% CI, 7.0–17] per 5 Hounsfield units) and chance of mortality (adjusted odds ratio, 0.83 [95% CI, 0.70–0.97]) decreased with higher thrombus attenuation increase in the overall population, without significant treatment interaction. Conclusions: Our study suggests that the benefit of best medical care including alteplase, compared with additional EVT, increases in patients with more pervious thrombi.
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Affiliation(s)
- Manon Kappelhof
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, the Netherlands. (M.K., M.L.T., K.M.T., B.G.D., H.A., G.Z., H.A.M., C.B.L.M.M.)
| | - Manon L Tolhuisen
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, the Netherlands. (M.K., M.L.T., K.M.T., B.G.D., H.A., G.Z., H.A.M., C.B.L.M.M.).,Biomedical Engineering and Physics, Amsterdam University Medical Center, University of Amsterdam, the Netherlands. (M.L.T., B.G.D., H.A., H.A.M.)
| | - Kilian M Treurniet
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, the Netherlands. (M.K., M.L.T., K.M.T., B.G.D., H.A., G.Z., H.A.M., C.B.L.M.M.)
| | - Bruna G Dutra
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, the Netherlands. (M.K., M.L.T., K.M.T., B.G.D., H.A., G.Z., H.A.M., C.B.L.M.M.).,Biomedical Engineering and Physics, Amsterdam University Medical Center, University of Amsterdam, the Netherlands. (M.L.T., B.G.D., H.A., H.A.M.)
| | - Heitor Alves
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, the Netherlands. (M.K., M.L.T., K.M.T., B.G.D., H.A., G.Z., H.A.M., C.B.L.M.M.).,Biomedical Engineering and Physics, Amsterdam University Medical Center, University of Amsterdam, the Netherlands. (M.L.T., B.G.D., H.A., H.A.M.)
| | - Guang Zhang
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, the Netherlands. (M.K., M.L.T., K.M.T., B.G.D., H.A., G.Z., H.A.M., C.B.L.M.M.)
| | - Scott Brown
- Altair Biostatistics, St Louis Park, MN (S. Brown)
| | - Keith W Muir
- Neuroscience & Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.)
| | - Antoni Dávalos
- Neuroscience, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain (A.D.)
| | - Yvo B W E M Roos
- Neurology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands. (Y.B.W.E.M.R.)
| | - Jeffrey L Saver
- Neurology, Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (J.L.S.)
| | - Andrew M Demchuk
- Clinical Neurosciences, University of Calgary, Alberta, Canada. (A.M.D., M.D.H.)
| | - Tudor G Jovin
- Neurology, University of Pittsburgh Medical Center, PA (T.G.J.)
| | - Serge Bracard
- Diagnostic and Interventional Neuroradiology, University of Lorraine, University Hospital of Nancy, France. (S. Bracard)
| | - Bruce C V Campbell
- Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. (B.C.V.C.)
| | - Aad van der Lugt
- Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands. (A.v.d.L.)
| | - Francis Guillemin
- Epidemiology, University of Lorraine, University Hospital of Nancy, France. (F.G.)
| | - Philip White
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom (P.W.)
| | - Michael D Hill
- Clinical Neurosciences, University of Calgary, Alberta, Canada. (A.M.D., M.D.H.)
| | | | - Peter J Mitchell
- Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. (P.J.M.)
| | - Mayank Goyal
- Radiology, University of Calgary, Alberta, Canada.(M.G.)
| | - Henk A Marquering
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, the Netherlands. (M.K., M.L.T., K.M.T., B.G.D., H.A., G.Z., H.A.M., C.B.L.M.M.).,Biomedical Engineering and Physics, Amsterdam University Medical Center, University of Amsterdam, the Netherlands. (M.L.T., B.G.D., H.A., H.A.M.)
| | - Charles B L M Majoie
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, the Netherlands. (M.K., M.L.T., K.M.T., B.G.D., H.A., G.Z., H.A.M., C.B.L.M.M.)
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21
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Ye G, Cao R, Lu J, Qi P, Hu S, Chen K, Tan T, Chen J, Wang D. Histological composition behind CT-based thrombus density and perviousness in acute ischemic stroke. Clin Neurol Neurosurg 2021; 207:106804. [PMID: 34304067 DOI: 10.1016/j.clineuro.2021.106804] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clot composition could impact recanalization outcomes of thrombectomy, and preoperative imaging markers may help know about the histological components of thrombus. METHODS Consecutive patients who underwent thrombectomy from June 2017 to December 2019 were reviewed. The mean Hounsfield unit (HU) of thrombus (aHU) and contralateral artery (cHU) were recorded based on non-enhanced CT. The relative thrombus density was calculated (dHU=aHU-cHU). Hyperdense artery sign (HAS) was identified if dHU≥ 4HU. The clot perviousness was evaluated via thrombus attenuation increase (δHU) on contrast-enhanced CT compared to non-enhanced CT. Pervious clots were identified when δHU≥ 11HU. Tissue quantification for thrombus was based on Martius Scarlet Blue staining, using the Orbit Imaging Analysis Software. Spearman rank correlations was used to detect the association between imaging markers and clot composition. The differences in clinical characteristics were compared according to the presence of HAS or pervious clots. RESULTS Fifty-three patients were included. The dHU was positively correlated with erythrocyte fractions (r = 0.337, p = 0.014), while there was no significant association between aHU and erythrocyte components (r = 0.146, p = 0.296). HAS (+) patients showed a comparable proportion of modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3 (94.6% vs. 87.5%, p = 0.740) and modified Rankin Scale score (mRS) 0-2 (35.1% vs. 56.3%, p = 0.152) compared with those HAS (-). Forty-seven cases were available for the analysis of clot perviousness. Clot perviousness was negatively associated with platelet fractions (r = -0.577, p < 0.001). Patients with pervious clots also showed a comparable proportion of mTICI 2b-3 (86.2% vs. 100%, p = 0.283) and mRS 0-2 (37.9% vs. 50.0%, p = 0.416) compared with impervious clots. CONCLUSIONS This study suggests that relative thrombus density was positively correlated with erythrocyte fractions, while clot perviousness showed a negative relationship with platelet components. Yet, the presence of HAS or pervious clots did not show significant associations with recanalization and clinical outcomes. The conclusions should be drawn with caution.
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Affiliation(s)
- Gengfan Ye
- Department of Neurosurgery, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, PR China
| | - Ruoyao Cao
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China; Graduate School of Peking Union Medical College, Beijing, PR China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China; Graduate School of Peking Union Medical College, Beijing, PR China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Shen Hu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Kunpeng Chen
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Tianhua Tan
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China; Graduate School of Peking Union Medical College, Beijing, PR China
| | - Juan Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Sciences; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China; Graduate School of Peking Union Medical College, Beijing, PR China.
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22
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Monteiro A, Cortez GM, Waqas M, Rai HH, Baig AA, Dossani RH, Cappuzzo JM, Almayman F, Aghaebrahim A, Davies JM, Sauvageau E, Snyder KV, Hanel RA, Levy EI, Siddiqui AH. Comparison of effectiveness and outcomes among different thrombectomy techniques in acute basilar artery occlusion: a dual-center experience. Neurosurg Focus 2021; 51:E8. [PMID: 34198244 DOI: 10.3171/2021.4.focus21114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Acute basilar artery occlusion (BAO) is a rare large-vessel occlusion associated with high morbidity and mortality. Modern thrombectomy with stent retrievers and large-bore aspiration catheters is highly effective in achieving recanalization, but a direct comparison of different techniques for acute BAO has not been performed. Therefore, the authors sought to compare the technical effectiveness and clinical outcomes of stent retriever-assisted aspiration (SRA), aspiration alone (AA), and a stent retriever with or without manual aspiration (SR) for treatment of patients presenting with acute BAO and to evaluate predictors of clinical outcome in their cohort. METHODS A retrospective analysis of databases of large-vessel occlusion treated with endovascular intervention at two US endovascular neurosurgery centers was conducted. Patients ≥ 18 years of age with acute BAO treated between January 2013 and December 2020 with stent retrievers or large-bore aspiration catheters were included in the study. Demographic information, procedural details, angiographic results, and clinical outcomes were extracted for analysis. RESULTS Eighty-three patients (median age 67 years [IQR 58-76 years]) were included in the study; 33 patients (39.8%) were female. The median admission National Institutes of Health Stroke Scale (NIHSS) score was 16 (IQR 10-21). Intravenous alteplase was administered to 26 patients (31.3%). The median time from symptom onset to groin or wrist puncture was 256 minutes (IQR 157.5-363.0 minutes). Overall, successful recanalization was achieved in 74 patients (89.2%). The SRA technique had a significantly higher rate of modified first-pass effect (mFPE; 55% vs 31.8%, p = 0.032) but not true first-pass effect (FPE; 45% vs 34.9%, p = 0.346) than non-SRA techniques. Good outcome (modified Rankin Scale [mRS] score 0-2) was not significantly different among the three techniques. Poor outcome (mRS score 3-6) was associated with a higher median admission NIHSS score (12.5 vs 19, p = 0.007), a higher rate of adjunctive therapy usage (9% vs 0%, p < 0.001), and a higher rate of intraprocedural complications (10.7% vs 14.5%, p = 0.006). The admission NIHSS score significantly predicted good outcome (OR 0.98, 95% CI 0.97-0.099; p = 0.032). Incomplete recanalization after thrombectomy significantly predicted mortality (OR 1.68, 95% CI 1.18-2.39; p = 0.005). CONCLUSIONS The evaluated techniques resulted in high recanalization rates. The SRA technique was associated with a higher rate of mFPE than AA and SR, but the clinical outcomes were similar. A lower admission NIHSS score predicted a better prognosis for patients, whereas incomplete recanalization after thrombectomy predicted mortality.
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Affiliation(s)
- Andre Monteiro
- Departments of1Neurosurgery.,2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health
| | - Gustavo M Cortez
- 3Department of Cerebrovascular and Endovascular Surgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, Florida
| | - Muhammad Waqas
- Departments of1Neurosurgery.,2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health
| | - Hamid H Rai
- Departments of1Neurosurgery.,2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health
| | - Ammad A Baig
- Departments of1Neurosurgery.,2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health
| | - Rimal H Dossani
- Departments of1Neurosurgery.,2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health
| | - Justin M Cappuzzo
- Departments of1Neurosurgery.,2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health
| | - Faisal Almayman
- Departments of1Neurosurgery.,2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health
| | - Amin Aghaebrahim
- 3Department of Cerebrovascular and Endovascular Surgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, Florida
| | - Jason M Davies
- Departments of1Neurosurgery.,2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health.,4Bioinformatics, and.,6Jacobs Institute, Buffalo, New York; and
| | - Eric Sauvageau
- 3Department of Cerebrovascular and Endovascular Surgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, Florida
| | - Kenneth V Snyder
- Departments of1Neurosurgery.,2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health.,5Canon Stroke and Vascular Research Center, University at Buffalo.,6Jacobs Institute, Buffalo, New York; and
| | - Ricardo A Hanel
- 3Department of Cerebrovascular and Endovascular Surgery, Baptist Neurological Institute and Lyerly Neurosurgery, Jacksonville, Florida
| | - Elad I Levy
- Departments of1Neurosurgery.,2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health.,5Canon Stroke and Vascular Research Center, University at Buffalo.,7Radiology, Jacobs School of Medicine and Biomedical Sciences, and
| | - Adnan H Siddiqui
- Departments of1Neurosurgery.,2Department of Neurosurgery, Gates Vascular Institute at Kaleida Health.,5Canon Stroke and Vascular Research Center, University at Buffalo.,7Radiology, Jacobs School of Medicine and Biomedical Sciences, and
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23
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Boodt N, Snouckaert van Schauburg PRW, Hund HM, Fereidoonnezhad B, McGarry JP, Akyildiz AC, van Es ACGM, De Meyer SF, Dippel DWJ, Lingsma HF, van Beusekom HMM, van der Lugt A, Gijsen FJH. Mechanical Characterization of Thrombi Retrieved With Endovascular Thrombectomy in Patients With Acute Ischemic Stroke. Stroke 2021; 52:2510-2517. [PMID: 34078112 PMCID: PMC8312567 DOI: 10.1161/strokeaha.120.033527] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose: Mechanical properties of thromboemboli play an important role in the efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke. However, very limited data on mechanical properties of human stroke thrombi are available. We aimed to mechanically characterize thrombi retrieved with EVT, and to assess the relationship between thrombus composition and thrombus stiffness. Methods: Forty-one thrombi from 19 patients with acute stroke who underwent EVT between July and October 2019 were mechanically analyzed, directly after EVT. We performed unconfined compression experiments and determined tangent modulus at 75% strain (Et75) as a measure for thrombus stiffness. Thrombi were histologically analyzed for fibrin/platelets, erythrocytes, leukocytes, and platelets, and we assessed the relationship between histological components and Et75 with univariable and multivariable linear mixed regression. Results: Median Et75 was 560 (interquartile range, 393–1161) kPa. In the multivariable analysis, fibrin/platelets were associated with increased Et75 (aβ, 9 [95% CI, 5 to 13]) kPa, erythrocytes were associated with decreased Et75% (aβ, −9 [95% CI, −5 to −13]) kPa. We found no association between leukocytes and Et75. High platelet values were strongly associated with increased Et75 (aβ, 56 [95% CI, 38–73]). Conclusions: Fibrin/platelet content of thrombi retrieved with EVT for acute ischemic stroke is strongly associated with increased thrombus stiffness. For thrombi with high platelet values, there was a very strong relationship with thrombus stiffness. Our data provide a basis for future research on the development of next-generation EVT devices tailored to thrombus composition.
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Affiliation(s)
- Nikki Boodt
- Department of Radiology and Nuclear Medicine (N.K., P.R.W.S.v.S., A.C.G.M.v.E.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.,Department of Neurology (N.K., D.W.J.D., A.v.d.L.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.,Department of Public Health (N.B., H.F.L.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Philip R W Snouckaert van Schauburg
- Department of Radiology and Nuclear Medicine (N.K., P.R.W.S.v.S., A.C.G.M.v.E.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.,Department of Biomedical Engineering, Delft University of Technology, the Netherlands (P.R.W.S.v.S., A.C.A.)
| | - Hajo M Hund
- Department of Radiology, Haaglanden Medical Center, The Hague, the Netherlands (H.M.H.)
| | | | - J Patrick McGarry
- School of Engineering, National University of Ireland Galway (B.F., J.P.M.)
| | - Ali C Akyildiz
- Department of Biomedical Engineering (A.C.A., F.J.H.G.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.,Department of Biomedical Engineering, Delft University of Technology, the Netherlands (P.R.W.S.v.S., A.C.A.)
| | - Adriaan C G M van Es
- Department of Radiology and Nuclear Medicine (N.K., P.R.W.S.v.S., A.C.G.M.v.E.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.,Department of Radiology, Leiden University Medical Center, the Netherlands (A.C.G.M.v.E.)
| | - Simon F De Meyer
- KU Leuven Campus Kulak Kortrijk, Laboratory for Thrombosis Research, Belgium (S.F.D.M.)
| | - Diederik W J Dippel
- Department of Neurology (N.K., D.W.J.D., A.v.d.L.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Hester F Lingsma
- Department of Public Health (N.B., H.F.L.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Heleen M M van Beusekom
- Department of Cardiology (H.M.M.v.B.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | | | - Frank J H Gijsen
- Department of Public Health (N.B., H.F.L.), Erasmus MC, University Medical Center Rotterdam, the Netherlands
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24
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Ding YH, Fitzgerald S, Liu Y, Dai D, Jakaitis D, Doyle K, Brinjikji W, Kallmes DF, Savastano L, Kadirvel R. A novel rabbit thromboembolic occlusion model. J Neurointerv Surg 2021; 13:1040-1043. [PMID: 33574137 DOI: 10.1136/neurintsurg-2020-017073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND To develop a preclinical thromboembolic occlusion model for studying revascularization strategies. METHODS Clot analog with barium sulfate was injected into the distal aorta in 9 New Zealand white rabbits. The situation of aorta occlusion was compared among fibrin-rich (n=4), red blood cell (RBC)-rich (n=3), and whole blood clot analogs (n=2) using digital subtraction angiography. Arterial geometries, histologic features and circumferential stretch of the distal aorta in rabbits were compared with the common carotid artery in swine and the distal internal carotid artery (ICA) in humans. Aspiration thrombectomy and mechanical thrombectomy using a stent retriever were performed in two rabbits. RESULTS The aortic bifurcation was occluded after a single delivery of clot in 4 cases. It was occluded after the second clot injection in the 5 remaining rabbits. Fragmentation of RBC-rich clots occurred during clot injection in 2 cases. The mean diameters of the distal aorta and right common iliac artery in rabbits were 3.7±0.4 and 2.8±0.3 mm, respectively; the mean diameters of human ICA, and first and second segments of the middle cerebral artery (M1, M2) were 3.6±0.4, 3.1±0.4, and 2.4±0.4 mm, respectively. Arterial revascularization was achieved in both rabbits. Geometric, mechanical and histological factors of the distal aorta in rabbit were more close to human distal ICA than swine carotid artery. CONCLUSION Arterial occlusion can be achieved at the aortic bifurcation in rabbits, which is comparable to human ICA bifurcation. This thrombectomy model has the potential to be used for testing of thrombectomy devices.
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Affiliation(s)
| | - Seán Fitzgerald
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Yang Liu
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daying Dai
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Karen Doyle
- Physiology, CURAM, National University of Ireland Galway, Galway, Ireland
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25
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Hanning U, Sporns PB, Psychogios MN, Jeibmann A, Minnerup J, Gelderblom M, Schulte K, Nawabi J, Broocks G, Meyer L, Krähling H, Brehm A, Wildgruber M, Fiehler J, Kniep H. Imaging-based prediction of histological clot composition from admission CT imaging. J Neurointerv Surg 2021; 13:1053-1057. [PMID: 33483457 DOI: 10.1136/neurintsurg-2020-016774] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/14/2020] [Accepted: 12/23/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Thrombus composition has been shown to be a major determinant of recanalization success and occurrence of complications in mechanical thrombectomy. The most important parameters of thrombus behavior during interventional procedures are relative fractions of fibrin and red blood cells (RBCs). We hypothesized that quantitative information from admission non-contrast CT (NCCT) and CT angiography (CTA) can be used for machine learning based prediction of thrombus composition. METHODS The analysis included 112 patients with occlusion of the carotid-T or middle cerebral artery who underwent thrombectomy. Thrombi samples were histologically analyzed and fractions of fibrin and RBCs were determined. Thrombi were semi-automatically delineated in CTA scans and NCCT scans were registered to the same space. Two regions of interest (ROIs) were defined for each thrombus: small-diameter ROIs capture vessel walls and thrombi, large-diameter ROIs reflect peri-vascular tissue responses. 4844 quantitative image markers were extracted and evaluated for their ability to predict thrombus composition using random forest algorithms in a nested fivefold cross validation. RESULTS Test set receiver operating characteristic area under the curve was 0.83 (95% CI 0.80 to 0.87) for differentiating RBC-rich thrombi and 0.84 (95% CI 0.80 to 0.87) for differentiating fibrin-rich thrombi. At maximum Youden-Index, RBC-rich thrombi were identified at 77% sensitivity and 74% specificity; for fibrin-rich thrombi the classifier reached 81% sensitivity at 73% specificity. CONCLUSIONS Machine learning based analysis of admission imaging allows for prediction of clot composition. Perspectively, such an approach could allow selection of clot-specific devices and retrieval procedures for personalized thrombectomy strategies.
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Affiliation(s)
- Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Peter B Sporns
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Marios N Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Astrid Jeibmann
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Jens Minnerup
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Mathias Gelderblom
- Department of Neurology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Karolin Schulte
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Jawed Nawabi
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany.,Department of Radiology, Charité School of Medicine and University Hospital Berlin, Berlin, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Hermann Krähling
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Alex Brehm
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Moritz Wildgruber
- Department of Radiology, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Helge Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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26
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Abbasi M, Liu Y, Fitzgerald S, Mereuta OM, Arturo Larco JL, Rizvi A, Kadirvel R, Savastano L, Brinjikji W, Kallmes DF. Systematic review and meta-analysis of current rates of first pass effect by thrombectomy technique and associations with clinical outcomes. J Neurointerv Surg 2021; 13:212-216. [PMID: 33441394 DOI: 10.1136/neurintsurg-2020-016869] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND First pass effect (FPE) in mechanical thrombectomy is thought to be associated with good clinical outcomes. OBJECTIVE To determine FPE rates as a function of thrombectomy technique and to compare clinical outcomes between patients with and without FPE. METHODS In July 2020, a literature search on FPE (defined as modified Thrombolysis in Cerebral Infarction (TICI) 2c-3 after a single pass) and modified FPE (mFPE, defined as TICI 2b-3 after a single pass) and mechanical thrombectomy for stroke was performed. Using a random-effects meta-analysis, we evaluated the following outcomes for both FPE and mFPE: overall rates, rates by thrombectomy technique, rates of good neurologic outcome (modified Rankin Scale score ≤2 at day 90), mortality, and symptomatic intracerebral hemorrhage (sICH) rate. RESULTS Sixty-seven studies comprising 16 870 patients were included. Overall rates of FPE and mFPE were 28% and 45%, respectively. Thrombectomy techniques shared similar FPE (p=0.17) and mFPE (p=0.20) rates. Higher odds of good neurologic outcome were found when we compared FPE with non-FPE (56% vs 41%, OR=1.78) and mFPE with non-mFPE (57% vs 44%, OR=1.73). FPE had a lower mortality rate (17% vs 25%, OR=0.62) than non-FPE. FPE and mFPE were not associated with lower sICH rate compared with non-FPE and non-mFPE (4% vs 18%, OR=0.41 for FPE; 5% vs 7%, OR=0.98 for mFPE). CONCLUSIONS Our findings suggest that approximately one-third of patients achieve FPE and around half of patients achieve mFPE, with equivalent results throughout thrombectomy techniques. FPE and mFPE are associated with better clinical outcomes.
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Affiliation(s)
- Mehdi Abbasi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yang Liu
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Seán Fitzgerald
- CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland.,Physiology Department, National University of Ireland Galway, Galway, Ireland
| | - Oana Madalina Mereuta
- CÚRAM-SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland.,Physiology Department, National University of Ireland Galway, Galway, Ireland
| | | | - Asim Rizvi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Luis Savastano
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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