Association between thrombus composition and first-pass recanalization after thrombectomy in acute ischemic stroke

Area of Science:

• Neurology
• Interventional Neuroradiology
• Biomedical Research

Background:

• First-pass recanalization (FPR) is crucial for optimal outcomes in acute ischemic stroke thrombectomy.
• Understanding factors hindering FPR is essential for improving treatment success rates.
• Thrombus composition is a potential key determinant of FPR efficacy.

Purpose of the Study:

• To investigate the relationship between the histological composition of cerebral thrombi and the success of first-pass recanalization.
• To identify specific thrombus components associated with successful versus failed FPR.

Main Methods:

• Histological analysis of 267 patient thrombi to assess red blood cells (RBCs), fibrin, platelets, leukocytes, and extracellular DNA.
• Correlation of thrombus composition with first-pass recanalization (FPR) achievement, defined by modified thrombolysis in cerebral infarction (mTICI) scores of 2c/3.

Main Results:

• Thrombi from successful FPR cases (mTICI 2c/3 in one pass) showed significantly higher RBC content (P=.0264).
• Conversely, thrombi requiring multiple passes for mTICI 2c/3 had significantly less fibrin (P=.0196) and less extracellular DNA (P=.0457).

Conclusions:

• Thrombus composition significantly influences first-pass recanalization rates in acute ischemic stroke.
• Lower red blood cell content, higher fibrin, and increased extracellular DNA are associated with reduced likelihood of FPR.
• Findings guide future research to enhance thrombectomy procedures and technologies for improved FPR, particularly in challenging thrombus types.