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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Risk of Thrombus Fragmentation during Endovascular Stroke Treatment
J Kaesmacher1, T Boeckh-Behrens1, S Simon2
1From the Departments of Neuroradiology (J.K., T.B.-B., C.M., J.F.K., C.Z., T.H.).
AJNR. American Journal of Neuroradiology
|March 11, 2017
Summary
Periprocedural thrombus fragmentation during stroke thrombectomy is linked to younger age and easier clot retrieval. Higher neutrophil elastase levels in clots increase fragmentation risk and reduce successful recanalization.
Area of Science:
- Neurology
- Interventional Radiology
- Pathology
Background:
- Periprocedural thrombus fragmentation is a significant risk during endovascular stroke treatment.
- Factors influencing thrombus fragmentation remain largely unknown, necessitating research into clot histology and stability.
Purpose of the Study:
- To investigate the relationship between thrombus histology and clot stability during endovascular stroke treatment.
- To identify histological factors associated with periprocedural thrombus fragmentation.
Main Methods:
- Retrospective analysis of 85 anterior circulation stroke patients undergoing thrombectomy.
- Evaluation of emboli number/location, maneuvers, and TICI scores post-thrombectomy.
- Histological analysis (H&E, neutrophil elastase staining) of retrieved thrombi correlated with procedural outcomes.
Main Results:
- Fewer retrieval maneuvers correlated with more distal emboli (Spearman r, -0.23; P = .032).
- Younger patients had a higher risk of fragmentation (Spearman r, -0.23; P = .032).
- Higher neutrophil elastase levels were independently associated with multiple emboli (aOR, 4.6) and lower recanalization rates (aOR, 0.3).
Conclusions:
- Younger age, easily retrieved thrombi, and bridging thrombolysis may increase fragmentation risk.
- Standard histology did not predict thrombectomy-relevant thrombus stability.
- Elevated neutrophil elastase in thrombi correlates with increased fragmentation risk and poorer recanalization, suggesting clinical relevance in stroke thrombectomy.
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