RT Journal Article
SR Electronic
T1 Risk of Thrombus Fragmentation during Endovascular Stroke Treatment
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 991
OP 998
DO 10.3174/ajnr.A5105
VO 38
IS 5
A1 J. Kaesmacher
A1 T. Boeckh-Behrens
A1 S. Simon
A1 C. Maegerlein
A1 J.F. Kleine
A1 C. Zimmer
A1 L. Schirmer
A1 H. Poppert
A1 T. Huber
YR 2017
UL http://www.ajnr.org/content/38/5/991.abstract
AB BACKGROUND AND PURPOSE: Periprocedural thrombus fragmentation is a relevant risk in endovascular stroke treatment. Because factors influencing its occurrence are largely unknown, this study addresses a potential relationship between thrombus histology and clot stability.MATERIALS AND METHODS: Eighty-five patients with anterior circulation stroke treated with thrombectomy were included in this retrospective study. The number and location of emboli after retrieving the primary thrombus, the number of maneuvers, and TICI scores were evaluated. H&E and neutrophil elastase staining of retrieved clots was performed, and semiquantitative measurements of thrombus components were correlated with procedural parameters.RESULTS: An inverse correlation between maneuvers required for thrombus retrieval and the number of distal and intermediate emboli was observed (Spearman r, −0.23; P = .032). Younger patients were at higher risk for periprocedural thrombus fragmentation (Spearman r, −0.23; P = .032). Bridging thrombolysis tended to be associated with fewer maneuvers (2 vs 3, P = .054) but more emboli (1 vs 0, P = .067). While no consistent correlation between procedural parameters and red/white blood cells and fibrin-/platelet fractions could be found, higher amounts of neutrophil elastase–positive cells within the thrombus were independently associated with the occurrence of multiple emboli (adjusted OR, 4.6; 95% CI, 1.1–19.7; P = .041) and lower rates of complete recanalization (adjusted OR, 0.3; 95% CI, 0.1–0.9; P = .050).CONCLUSIONS: Younger age, easy-to-retrieve thrombi, and bridging thrombolysis may be risk factors for periprocedural thrombus fragmentation. Findings from standard histologic stains did not provide insight into thrombectomy-relevant thrombus stability. However, higher neutrophil levels in the thrombus tissue were related to an increased risk of periprocedural thrombus fragmentation. This observation aligns with the proposed thrombolytic capacity of neutrophil elastase and points to its potential clinical relevance in the context of stroke thrombectomy.ACAanterior cerebral arteryF/Pfibrin-/platelet accumulationsIQRinterquartile rangeMTmechanical thrombectomyNEneutrophil elastasePOSprimary occlusion sitePTFperiprocedural thrombus fragmentationRBCred blood cellsWBCwhite blood cells