TY - JOUR
T1 - High-Resolution Imaging of Interaction Between Thrombus and Stent-Retriever in Patients With Acute Ischemic Stroke
AU - Autar, Anouchska S. A.
AU - Hund, Hajo M.
AU - Ramlal, Sharad A.
AU - Hansen, Daniel
AU - Nijeholt, Geert J. Lycklama A.
AU - Emmer, Bart J.
AU - de Maat, Moniek P. M.
AU - Dippel, Diederik W. J.
AU - van der Lugt, Aad
AU - van Es, Adriaan C. G. M.
AU - van Beusekom, Heleen M. M.
AU - MR CLEAN Registry Investigators
AU - Goldhoorn, Robert-Jan
AU - Staals, Julie
AU - Postma - Jacobi, Linda
AU - van Oostenbrugge, Robert Jan
AU - van Zwam, Wim
PY - 2018/7/3
Y1 - 2018/7/3
N2 - 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.
AB - 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.
KW - ischemic stroke
KW - mechanical thrombectomy
KW - scanning electron microscopy
KW - stent-retriever
KW - thrombus
KW - PREDICTS SUCCESSFUL RECANALIZATION
KW - MECHANICAL THROMBECTOMY
KW - FIBRIN
KW - CT
KW - REPERFUSION
KW - THERAPY
KW - DENSITY
KW - NETWORK
U2 - 10.1161/JAHA.118.008563
DO - 10.1161/JAHA.118.008563
M3 - Article
C2 - 29934420
SN - 2047-9980
VL - 7
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 13
M1 - 008563
ER -