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Research ArticleInterventional

The Impact of Thromboemboli Histology on the Performance of a Mechanical Thrombectomy Device

I. Yuki, I. Kan, H.V. Vinters, R.H. Kim, A. Golshan, F.A. Vinuela, J.W. Sayre, Y. Murayama and F. Vinuela
American Journal of Neuroradiology April 2012, 33 (4) 643-648; DOI: https://doi.org/10.3174/ajnr.A2842
I. Yuki
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I. Kan
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H.V. Vinters
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R.H. Kim
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A. Golshan
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F.A. Vinuela
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J.W. Sayre
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Y. Murayama
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F. Vinuela
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  • Fig 1.
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    Fig 1.

    A, Macroscopic view of 2 different experimental clots. A novel experimental clot (fibrin-rich clot) (left) is prepared by manually excising the fibrin-rich layer of swine clot, which is created by natural sedimentation. Fibrin-rich clot shows more solid and elastic mechanical properties than conventional thrombin-induced experimental clot (erythrocyte-rich clot) (right). B, Microscopic view of the experimental clots versus thromboembolus recovered from a patient with acute stoke (H&E, original magnification ×40). A microscopic view of an erythrocyte-rich clot (left) demonstrates a thrombus composed predominantly of erythrocytes with interspersed fibrin and barium sulfate deposits. A thromboembolus recovered from a patient with stroke (center) shows distinct layers of fibrin, nucleated cells, and erythrocytes. A fibrin-rich clot (right) produces a layered pattern of fibrin, nucleated cells, and erythrocytes similar to that seen in the clot recovered from the patient with stroke (center). F indicates fibrin component; Arrows, the cellular component; E, the erythrocyte component.

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    Fig 2.

    Bar graphs showing the number of attempts required to achieve the angiographic end point in each treated vessel. Every target vessel in group A achieved recanalization of TIMI grade 2 or greater, whereas only 3 of 8 vessels achieved recanalization in group B. None of the treated vessels that underwent 5 attempts of retrieval demonstrated significant recanalization (1 vessel with TIMI 1 and 4 vessels with TIMI 0).

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    Fig 3.

    Angiographic findings of a target vessel occluded with an erythrocyte-rich clot and treated with MT. A, Preprocedural angiogram of a right superficial cervical artery (anteroposterior view) shows the branching pattern of the artery. B, Complete occlusion of the vessel was confirmed after injection of an erythrocyte-rich clot. C, A Merci clot retriever device (V2.5 firm) was deployed distal to the occlusion site, and clot retrieval was performed. D, A postprocedural angiogram shows recanalization of the treated artery. Small residual thrombi distal to the bifurcation of the artery are also seen (arrow).

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    Fig 4.

    Angiographic findings of a target artery occluded with a fibrin-rich clot and treated with MT. A, A preprocedural angiogram of a left superficial cervical artery shows its branching pattern. B, Complete occlusion of the vessel was confirmed after injecting a fibrin-rich clot. C, A Merci clot retriever device (V2.5 firm) was deployed distal to the clot, and clot retrieval was performed. D, After 5 attempts at clot retrieval, the postprocedural angiogram shows that the treated vessel remains occluded.

Tables

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  • Comparison between the erythrocyte-rich clot group and the fibrin-rich clot group

    Erythrocyte-Rich Clot (Group A)Fibrin-Rich Clot (Group B)Level of Significance
    Total No. of treated vessels88N/A
    Total No. of attempts (times)1434P < .001
    Average No. of attempts per vessel (times)2.754.5P < .001
    Mean procedural time (min)15.581.5P < .01
    Final TIMI grade
        004
        201N/A
        352
        431
    • Note:—N/A indicates not applicable.

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American Journal of Neuroradiology: 33 (4)
American Journal of Neuroradiology
Vol. 33, Issue 4
1 Apr 2012
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The Impact of Thromboemboli Histology on the Performance of a Mechanical Thrombectomy Device
I. Yuki, I. Kan, H.V. Vinters, R.H. Kim, A. Golshan, F.A. Vinuela, J.W. Sayre, Y. Murayama, F. Vinuela
American Journal of Neuroradiology Apr 2012, 33 (4) 643-648; DOI: 10.3174/ajnr.A2842

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The Impact of Thromboemboli Histology on the Performance of a Mechanical Thrombectomy Device
I. Yuki, I. Kan, H.V. Vinters, R.H. Kim, A. Golshan, F.A. Vinuela, J.W. Sayre, Y. Murayama, F. Vinuela
American Journal of Neuroradiology Apr 2012, 33 (4) 643-648; DOI: 10.3174/ajnr.A2842
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  • Correlation of clot imaging with endovascular recanalization in internal carotid artery terminus occlusion
  • Human placenta as an ex vivo vascular model for neurointerventional research
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