Dynamic Perviousness Has Predictive Value for Clot Fibrin Content in Acute Ischemic Stroke

Area of Science:

• Neuroradiology
• Interventional Neurology
• Biomarker Development

Background:

• Acute ischemic stroke (AIS) is a leading cause of disability.
• Mechanical thrombectomy (MT) is a key treatment for large vessel occlusion (LVO) AIS.
• Understanding clot composition is crucial for optimizing MT outcomes.

Purpose of the Study:

• To investigate the correlation between dynamic perviousness and clot composition in AIS patients undergoing MT.
• To evaluate dynamic perviousness as an imaging biomarker for thrombus characteristics.

Main Methods:

• Thirty-nine LVO AIS patients undergoing MT were analyzed.
• Three-phase CT imaging was performed pre-MT to assess dynamic perviousness.
• Retrieved clots underwent histopathological analysis to determine composition (RBC-rich, fibrin/platelet-rich, mixed).

Main Results:

• Dynamic perviousness patterns differed significantly between fibrin-rich clots and RBC-rich/mixed clots.
• Fibrin-rich clots were less common in the 'uptake without washout' category compared to 'uptake with washout' (p=0.036).
• Contrast uptake patterns, including washout, significantly predicted the likelihood of fibrin-rich clots.

Conclusions:

• Dynamic perviousness is a promising imaging biomarker for characterizing AIS clot composition.
• Specific contrast uptake and washout patterns correlate with fibrin-rich thrombi, potentially guiding treatment strategies.
• Further research can explore the clinical utility of dynamic perviousness in predicting MT success.