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Published on: September 25, 2016
Histopathological and Bacteriological Analysis of Thrombus Material Extracted During Mechanical Thrombectomy in Acute
Francisco Hernández-Fernández1, Laura Rojas-Bartolomé2, Jorge García-García2
1Neurology Department, Complejo Hospitalario Universitario de Albacete, Hermanos Falco 37, 02008, Albacete, Spain. fco.hdez.fdez@gmail.com.
Purpose:
Management of stroke secondary to septic emboli (SE) remains challenging, due to both the lack of specific recommendations and the gravity of the underlying pathology.The aim of this study is to describe the presence of SE in a series of mechanical thrombectomies (MT), analyzing technical complexity and outcomes with respect to the patients by means of histological analysis and microbiological study of the clot.
Methods:
All the retrieved clots were studied under an established protocol, including histopathological and bacteriological study with hematoxylin-eosin, Gram and Gomori trichrome staining.Technical complexity in SE with respect to the series was evaluated by analyzing time of the procedures, number of passes and use of intracranial definitive stents.
Results:
Over a 24-month period, bacteria were detected in the retrieved clot of four out of 65 patients (incidence 6.2%). Two cases were eventually diagnosed with infective endocarditis, while the remaining two were diagnosed with urinary tract infection and respiratory septicemia, respectively. Three of the four patients (75%) required an intracranial definitive stent in order to achieve successful recanalization.These procedures were significantly longer (137.7 vs. 59.8 min, p < 0.001), needed a higher number of passes (5.8 vs. 2.2, p < 0.001), and delivery of an intracranial stent more frequently (75% vs. 1.6%, p = 0.008), with respect to the rest of the series.
Conclusions:
In our series, systematic histopathological and bacteriological study of the MT samples allowed a higher proportion of SE diagnosis in comparison with previous reports.
Insights
Septic emboli (SE) in stroke patients are challenging to manage. Histological analysis of clots during mechanical thrombectomy (MT) identified SE in 6.2% of cases, revealing higher procedural complexity.
Area of Science:
- Neurology
- Infectious Diseases
- Interventional Neuroradiology
Background:
- Stroke secondary to septic emboli (SE) presents diagnostic and therapeutic challenges.
- Limited specific recommendations exist for managing SE-related stroke.
- Underlying pathology of SE contributes to poor patient outcomes.
Purpose of the Study:
- To identify the incidence of SE in patients undergoing mechanical thrombectomy (MT).
- To analyze the technical complexity of MT for SE.
- To evaluate patient outcomes based on histological and microbiological clot analysis.
Main Methods:
- Retrieved clots underwent histopathological and bacteriological examination (H&E, Gram, Gomori trichrome staining).
- Technical complexity assessed by procedure duration, number of passes, and stent use.
- Comparison of SE cases with non-SE cases within the MT series.
Main Results:
- Bacteria detected in 4 out of 65 retrieved clots (6.2% incidence).
- Identified sources of SE included infective endocarditis, UTI, and respiratory septicemia.
- SE cases required significantly longer procedures (137.7 vs. 59.8 min), more passes (5.8 vs. 2.2), and frequent stent use (75% vs. 1.6%).
Conclusions:
- Systematic histopathological and bacteriological analysis of MT samples increases SE diagnosis rates.
- SE cases present higher technical complexity during MT.
- This diagnostic approach aids in identifying SE, which may have been previously underreported.
