High-Resolution Imaging of Interaction Between Thrombus and Stent-Retriever in Patients With Acute Ischemic Stroke

Anouchska S. A. Autar, Hajo M. Hund, Sharad A. Ramlal, Daniel Hansen, Geert J. Lycklama A. Nijeholt, Bart J. Emmer, Moniek P. M. de Maat, Diederik W. J. Dippel, Aad van der Lugt, Adriaan C. G. M. van Es, Heleen M. M. van Beusekom*, MR CLEAN Registry Investigators, Robert-Jan Goldhoorn, Julie Staals, Linda Postma - Jacobi, Robert Jan van Oostenbrugge, Wim van Zwam

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background-Currently, acute ischemic stroke is still a leading cause of mortality and morbidity. Approximately 2 years ago, mechanical thrombectomy was proven beneficial as a revolutionary new therapy for stroke in the MR-CLEAN trial (A Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). However, the mechanisms by which the thrombectomy device, or stent-retriever, interacts with the thrombus are largely unknown. A better understanding could lead to improved efficacy of mechanical thrombectomy devices.

Methods and Results-Seven stent-retrievers with thrombi still entrapped were collected directly after thrombectomy. The stent-retrievers were studied using micro computed tomography, followed by scanning electron microscopy and light microscopy. Two independent observers rated interaction type and thrombus surface structure (porous filamentous or dense) at the interaction sites. A total of 79 interaction sites between thrombus and stent-retriever were categorized. Thrombus-stent-retriever interaction was found to be adhesive (n=44; 56%) or mechanical (n=35; 44%). Adhesive interaction was most frequently observed at interaction sites with a dense surface, compared with interaction sites with a porous filamentous fibrin surface (38/58; 66% versus 6/21; 29%, P=0.011).

Conclusions-The interaction between thrombus and stent-retriever was predominantly adhesive, not mechanical. Adhesive interaction was strongly associated with the presence of a dense thrombus surface without a porous filamentous fibrin network.

Original languageEnglish
Article number008563
Number of pages20
JournalJournal of the American Heart Association
Issue number13
Publication statusPublished - 3 Jul 2018


  • ischemic stroke
  • mechanical thrombectomy
  • scanning electron microscopy
  • stent-retriever
  • thrombus
  • CT

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