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Ospel JM, Mirza M, Clarençon F, Siddiqui A, Doyle K, Consoli A, Mokin M, Ullberg T, Zaidat O, Bourcier R, Kulcsar Z, Gounis MJ, Liebeskind DS, Fiehler J, Narata AP, Ribo M, Jovin T, Sakai N, Rai A, McCarthy R, Dorn F, Andersson T, Majoie CBLM, Hanel R, Jadhav A, Riedel C, Chamorro A, Brinjikji W, Costalat V, DeMeyer SF, Nogueira RG, Cognard C, Montaner J, Leung TW, Molina C, van Beusekom H, Davalos A, Weisel J, Chapot R, Möhlenbruch M, Brouwer P. What is a Challenging Clot? : A DELPHI Consensus Statement from the CLOTS 7.0 Summit. Clin Neuroradiol 2023; 33:1007-1016. [PMID: 37284876 DOI: 10.1007/s00062-023-01301-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/27/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Predicting a challenging clot when performing mechanical thrombectomy in acute stroke can be difficult. One reason for this difficulty is a lack of agreement on how to precisely define these clots. We explored the opinions of stroke thrombectomy and clot research experts regarding challenging clots, defined as difficult to recanalize clots by endovascular approaches, and clot/patient features that may be indicative of such clots. METHODS A modified DELPHI technique was used before and during the CLOTS 7.0 Summit, which included experts in thrombectomy and clot research from different specialties. The first round included open-ended questions and the second and final rounds each consisted of 30 closed-ended questions, 29 on various clinical and clot features, and 1 on number of passes before switching techniques. Consensus was defined as agreement ≥ 50%. Features with consensus and rated ≥ 3 out of 4 on the certainty scale were included in the definition of a challenging clot. RESULTS Three DELPHI rounds were performed. Panelists achieved consensus on 16/30 questions, of which 8 were rated 3 or 4 on the certainty scale, namely white-colored clots (mean certainty score 3.1), calcified clots under histology (3.7) and imaging (3.7), stiff clots (3.0), sticky/adherent clots (3.1), hard clots (3.1), difficult to pass clots (3.1) and clots that are resistant to pulling (3.0). Most panelists considered switching endovascular treatment (EVT) techniques after 2-3 unsuccessful attempts. CONCLUSION This DELPHI consensus identified 8 distinct features of a challenging clot. The varying degree of certainty amongst the panelists emphasizes the need for more pragmatic studies to enable accurate a priori identification of such occlusions prior to EVT.
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Affiliation(s)
- Johanna M Ospel
- Departments of Diagnostic Imaging and Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, T2N2T9, Calgary, AB, Canada.
| | | | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Adnan Siddiqui
- Department of Neurosurgery, University of New York at Buffalo, Buffalo, NY, USA
| | - Karen Doyle
- Department of Physiology and CURAM-SFI Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Arturo Consoli
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital Foch, Suresnes, France
| | - Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, USA
| | - Teresa Ullberg
- Departments of Neurology and Diagnostic Imaging, Skåne University Hospital, and Department of clinical sciences, Neurology, Lund University, Lund, Sweden
| | - Osama Zaidat
- Neuroscience and Stroke Center, Mercy Health Bon Secours St Vincent Hospital, Toledo, OH, USA
| | - Romain Bourcier
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Nantes, Pays de la Loire, France
| | - Zsolt Kulcsar
- Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland
| | - Matthew J Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Chan Medical School, Worcester, USA
| | - David S Liebeskind
- UCLA Stroke Center and Department of Neurology, University of California, Los Angeles, USA
| | - Jens Fiehler
- Department of Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ana Paula Narata
- Department of Interventional Neuroradiology, University Hospital of Southampton, Southampton, UK
| | - Marc Ribo
- Unitat d'Ictus, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Tudor Jovin
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ansaar Rai
- Neuroradiology Department, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, USA
| | - Ray McCarthy
- Research and Development, Cerenovus, Galway, Ireland
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital of Bonn, Bonn, Germany
| | - Tommy Andersson
- Department of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Intitutet, Stockholm, Sweden
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Ricardo Hanel
- Baptist neurological institute, Baptist Health, Jacksonville, FL, USA
| | - Ashutosh Jadhav
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Christian Riedel
- Department of Neuroradiology, University Hospital Göttingen, Georg-August-University, Göttingen, Germany
| | - Angel Chamorro
- Hospital Clinic of Barcelona and Institut d'Investigaçions Biomèdicas August Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Waleed Brinjikji
- Department of Radiology and Neurosurgery, Mayo Clinic Rochester, Rochester, MN, USA
| | - Vincent Costalat
- Neuroradiology department, University Hospital Güi-de-Chauliac, CHU de Montpellier, Montpellier, France
| | - Simon F DeMeyer
- Laboratory For Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Raul G Nogueira
- Department of Neurology, University of Pittsburgh Medical Centre, Pittsburgh, USA
| | - Christophe Cognard
- Department of diagnostic and therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR) Barcelona, Barcelona, Spain
| | - Thomas W Leung
- Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Carlos Molina
- Stroke Center Vall d'Hebron Hospital, Barcelona, Spain
| | - Heleen van Beusekom
- Department of Cardiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Antoni Davalos
- Department of Neuroscience, University Autònoma de Barcelona, Barcelona, Spain
| | - John Weisel
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Rene Chapot
- Department of Neuroradiology, Alfried Krupp Krankenhaus Ruttenscheid, Essen, Germany
| | - Markus Möhlenbruch
- Department of Interventional Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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Liu R, He H, Zhang L, Fan Y, Wang J, Wang W. In vitro models for the experimental evaluation of mechanical thrombectomy devices in acute ischemic stroke. Interv Neuroradiol 2023; 29:759-767. [PMID: 35971288 PMCID: PMC10680957 DOI: 10.1177/15910199221118404] [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: 05/11/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
Mechanical thrombectomy has become an important method for the treatment of acute ischemic stroke for large vessel occlusions. The current hotspots of mechanical thrombectomy are optimizing the treatment methods, improving the recanalization rate and reducing complications. The in vitro model has become a common and convenient method for mechanical thrombectomy research. This review summarizes the in vitro model in the following aspects: the preparation of clot analogues; the experimental platform; the application of the in vitro model in the testing of thrombectomy devices; and the advantages, limitations and future trends of the in vitro experimental model. This review describes the characteristics and applications of the in vitro experimental model with the hope that the in vitro experimental model will be further improved and play a more effective role in the study of mechanical thrombectomy.
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Affiliation(s)
- Ronghui Liu
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beihang University, Beijing, China
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China
| | - Hongping He
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China
| | - Luo Zhang
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China
| | - Yubo Fan
- School of Biological Science and Medical Engineering, Beijing Advanced Innovation Center for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beihang University, Beijing, China
| | - Jun Wang
- Department of Neurology, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Weidong Wang
- Key Laboratory of Biomedical Engineering and Translational Medicine, Ministry of Industry and Information Technology, Research Center for Biomedical Engineering, Medical Innovation & Research Division, Chinese PLA General Hospital, Beijing, China
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Lehnen NC, Paech D, Zülow S, Bode FJ, Petzold GC, Radbruch A, Dorn F. First Experience with the Nimbus Stentretriever. Clin Neuroradiol 2022; 33:491-497. [DOI: 10.1007/s00062-022-01237-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022]
Abstract
Abstract
Purpose
To share our first experience with the Nimbus stentretriever, a multizone device designed to assist neurointerventionalists in handling fibrin-rich clots in endovascular stroke treatment.
Methods
We retrospectively analyzed the data of patients who were treated with the Nimbus stentretriever at our high-volume stroke center between May 2021 and May 2022. We evaluated the number of passes before Nimbus was used, the number of passes with nimbus, as well as the recanalization success before and after Nimbus according to the modified treatment in cerebral ischemia (mTICI) scale. Also, patient characteristics, procedural times and clinical outcomes were documented.
Results
A total of 21 consecutive patients were included in the study. An mTICI 2b/3 could be achieved in 76.2% and mTICI 2c/3 could be achieved in 57.1%. The mean number of passes was 3.4 before the use of Nimbus, 2.2 with Nimbus, and 5.4 for all passes with and without Nimbus and 4 occlusions (19.0%) were successfully recanalized with direct aspiration after the use of Nimbus. We observed seven subarachnoid hemorrhages (33.3%) and two cases of vasospasm.
Conclusion
In our series, the use of Nimbus resulted in successful recanalization in half of the patients after otherwise unsuccessful thrombectomy maneuvers; therefore, it should be considered as a rescue option if the maneuver with conventional stent retrievers was unsuccessful.
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Guerreiro H, Wortmann N, Andersek T, Ngo TN, Frölich AM, Krause D, Fiehler J, Kyselyova AA, Flottmann F. Novel synthetic clot analogs for in-vitro stroke modelling. PLoS One 2022; 17:e0274211. [PMID: 36083986 PMCID: PMC9462564 DOI: 10.1371/journal.pone.0274211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 08/19/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose
The increased demand for training of mechanical thrombectomy in ischemic stroke and development of new recanalization devices urges the creation of new simulation models both for training and device assessment. Clots properties have shown to play a role in procedural planning and thrombectomy device effectiveness. In this study, we analyzed the characteristics and applicability of completely synthetic, animal-free clots in the setting of an in-vitro model of mechanical thrombectomy for training and device assessment.
Methods
Synthetic clots based on agarose (n = 12) and silicone (n = 11) were evaluated in an in-vitro neurointervention simulation of mechanical thrombectomy with clot extraction devices. Calcified clots of mixed nature were simulated with addition of 3D printed structures. 9 clots were excluded due to insufficient vessel occlusion and failure to integrate with clot extraction device. Synthetic thrombi were characterized and compared using a categorical score-system on vessel occlusion, elasticity, fragmentation, adherence and device integration.
Results
Both agarose-based and silicone-based clots demonstrated relevant flow arrest and a good integration with the clot extraction device. Silicone-based clots scored higher on adherence to the vessel wall and elasticity.
Conclusion
Selected synthetic clots can successfully be implemented in an in-vitro training environment of mechanical thrombectomy. The clots’ different properties might serve to mimic fibrin-rich and red blood cell-rich human thrombi.
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Affiliation(s)
- Helena Guerreiro
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Nadine Wortmann
- Institute of Product Development and Mechanical Engineering Design, Hamburg University of Technology, Hamburg, Germany
| | - Thomas Andersek
- Institute of Product Development and Mechanical Engineering Design, Hamburg University of Technology, Hamburg, Germany
| | - Tuan N. Ngo
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas M. Frölich
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dieter Krause
- Institute of Product Development and Mechanical Engineering Design, Hamburg University of Technology, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna A. Kyselyova
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Flottmann
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Aspects of ischemic stroke biomechanics derived using ex-vivo and in-vitro methods relating to mechanical thrombectomy. J Biomech 2021; 131:110900. [PMID: 34954526 DOI: 10.1016/j.jbiomech.2021.110900] [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: 04/21/2021] [Revised: 10/01/2021] [Accepted: 12/02/2021] [Indexed: 12/11/2022]
Abstract
Establishing the underlying biomechanics of acute ischemic stroke (AIS) and its treatment is fundamental to developing more effective clinical treatments for one of society's most impactful diseases. Recent changes in AIS management, driven by clinical evidence of improved treatments, has already led to a rapid rate of innovation, which is likely to be sustained for many years to come. These unprecedented AIS triage and treatment innovations provide a great opportunity to better understand the disease. In this article we provide a perspective on the recreation of AIS in the laboratory to inform contemporary device design and procedural techniques in mechanical thrombectomy. Presentation of these findings, which have been used to solve the applied problem of designing mechanical thrombectomy devices, is intended to help inform the development of basic biomechanics solutions for AIS.
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Soize S, Eymard JB, Cheikh-Rouhou S, Manceau PF, Gelmini C, Sahnoun M, Gawlitza M, Zuber M, Pierot L, Touzé E. Fast Stent Retrieval during Mechanical Thrombectomy Improves Recanalization in Patients with the Negative Susceptibility Vessel Sign. AJNR Am J Neuroradiol 2021; 42:726-731. [PMID: 33574100 DOI: 10.3174/ajnr.a6989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/02/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND PURPOSE In acute ischemic stroke, the negative susceptibility vessel sign on T2*-weighted images traditionally highlights fibrin-rich clots, which are particularly challenging to remove. In vitro, fast stent retrieval improves fibrin-rich clot extraction. We aimed to evaluate whether the speed of stent retrieval influences the recanalization and clinical outcome of patients presenting with the negative susceptibility vessel sign. MATERIALS AND METHODS Patients were identified from a registry of patients with ischemic stroke receiving mechanical thrombectomy between January 2016 and January 2020. Inclusion criteria were the following: 1) acute ischemic stroke caused by an isolated occlusion of the anterior circulation involving the MCA (Internal Carotid Artery-L, M1, M2) within 8 hours of symptom onset; 2) a negative susceptibility vessel sign on prethrombectomy T2*-weighted images; and 3) treatment with a combined technique (stent retriever + contact aspiration). Patients were dichotomized according to retrieval speed (fast versus slow). The primary outcome was the first-pass recanalization rate. RESULTS Of 68 patients who met inclusion criteria, 31 (45.6%) were treated with fast retrieval. Patients receiving a fast retrieval had greater odds of first-pass complete (relative risk and 95% confidence interval [RR 95% CI], 4.30 [1.80-10.24]), near-complete (RR 95% CI, 3.24 [1.57-6.68]), and successful (RR 95% CI, 2.60 [1.53-4.43]) recanalization as well as greater odds of final complete (RR 95% CI, 4.18 [1.93-9.04]), near-complete (RR 95% CI, 2.75 [1.55-4.85]), and successful (RR 95% CI, 1.52 [1.14-2.03]) recanalization. No significant statistical differences in procedure-related serious adverse events, distal embolization, or symptomatic intracranial hemorrhage were reported. No differences were noted in terms of functional independence (RR 95% CI, 1.01 [0.53-1.93]) and all-cause mortality (RR 95% CI, 0.90 [0.35-2.30]) at 90 days. CONCLUSIONS A fast stent retrieval during mechanical thrombectomy is safe and improves the retrieval of clots with the negative susceptibility vessel sign.
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Affiliation(s)
- S Soize
- From the Unité Mixte de recherche-S U1237 (S.S., M.Z., E.T.), Institut National de la Santé et de la Recherche Médicale, Normandie University , Université Caen-Normandie, Cyceron, Caen, France .,Department of Neuroradiology (S.S., J.-B.E., S.C.-R., P.-F.M., C.G., M.S., M.G., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Université de Champagne-Ardenne, Reims, France
| | - J-B Eymard
- Department of Neuroradiology (S.S., J.-B.E., S.C.-R., P.-F.M., C.G., M.S., M.G., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Université de Champagne-Ardenne, Reims, France
| | - S Cheikh-Rouhou
- Department of Neuroradiology (S.S., J.-B.E., S.C.-R., P.-F.M., C.G., M.S., M.G., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Université de Champagne-Ardenne, Reims, France
| | - P-F Manceau
- Department of Neuroradiology (S.S., J.-B.E., S.C.-R., P.-F.M., C.G., M.S., M.G., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Université de Champagne-Ardenne, Reims, France
| | - C Gelmini
- Department of Neuroradiology (S.S., J.-B.E., S.C.-R., P.-F.M., C.G., M.S., M.G., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Université de Champagne-Ardenne, Reims, France
| | - M Sahnoun
- Department of Neuroradiology (S.S., J.-B.E., S.C.-R., P.-F.M., C.G., M.S., M.G., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Université de Champagne-Ardenne, Reims, France
| | - M Gawlitza
- Department of Neuroradiology (S.S., J.-B.E., S.C.-R., P.-F.M., C.G., M.S., M.G., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Université de Champagne-Ardenne, Reims, France
| | - M Zuber
- From the Unité Mixte de recherche-S U1237 (S.S., M.Z., E.T.), Institut National de la Santé et de la Recherche Médicale, Normandie University , Université Caen-Normandie, Cyceron, Caen, France.,Department of Neurology (M.Z.), Université de Paris, Hôpital Saint-Joseph, Paris, France
| | - L Pierot
- Department of Neuroradiology (S.S., J.-B.E., S.C.-R., P.-F.M., C.G., M.S., M.G., L.P.), Hôpital Maison Blanche, Centre Hospitalier Universitaire de Reims, Université de Champagne-Ardenne, Reims, France
| | - E Touzé
- From the Unité Mixte de recherche-S U1237 (S.S., M.Z., E.T.), Institut National de la Santé et de la Recherche Médicale, Normandie University , Université Caen-Normandie, Cyceron, Caen, France.,Department of Neurology (E.T.), Centre Hospitalier Universitaire Caen Normandie, Caen, France
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Jolugbo P, Ariëns RAS. Thrombus Composition and Efficacy of Thrombolysis and Thrombectomy in Acute Ischemic Stroke. Stroke 2021; 52:1131-1142. [PMID: 33563020 DOI: 10.1161/strokeaha.120.032810] [Citation(s) in RCA: 165] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Thrombi retrieved from patients with acute ischemic stroke are highly heterogeneous. Recent data suggest that thrombus composition may impact on mechanical thrombectomy, the number of recanalization manoeuvres, resistance to retrieval, and on thrombolytic potential. Our aim was to summarize evidence describing the impact of thrombus composition on efficacy of mechanical thrombectomy and thrombolysis in patients with acute ischemic stroke. The scoping review methodology guided by the Joanna Briggs Institute, an adaption of the Arksey and O'Malley, was followed. Comprehensive searches were conducted in MEDLINE, EMBASE, SCOPUS, and Web of Science. Articles were classified into 4 key themes: (1) composition of stroke thrombi, (2) thrombus composition and mechanical thrombectomy, (3) thrombus composition and thrombolytic therapy, and (4) novel imaging and endovascular approaches. Our search identified 698 articles published from 1987 to June 2020. Additional articles were extracted from reference lists of the selected articles. Overall, 95 topic-specific articles identified for inclusion published in 40 different journals were included. Reports showed that thrombus composition in stroke was highly heterogeneous, containing fibrin, platelets, red blood cells, VWF (von Willebrand Factor), and neutrophil extracellular traps. Thrombi could roughly be divided into fibrin- and red blood cell-rich clots. Fibrin-rich clots were associated with increased recanalization manoeuvres, longer procedure time, and less favorable clinical outcomes compared with red blood cell-rich clots. Advances in detection or treatment of thrombi that take into account clot heterogeneity may be able to improve future endovascular and thrombolytic treatment of stroke.
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Affiliation(s)
- Precious Jolugbo
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
| | - Robert A S Ariëns
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom
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