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Research ArticleINTERVENTIONAL

Risk of Thrombus Fragmentation during Endovascular Stroke Treatment

J. Kaesmacher, T. Boeckh-Behrens, S. Simon, C. Maegerlein, J.F. Kleine, C. Zimmer, L. Schirmer, H. Poppert and T. Huber
American Journal of Neuroradiology May 2017, 38 (5) 991-998; DOI: https://doi.org/10.3174/ajnr.A5105
J. Kaesmacher
aFrom the Departments of Neuroradiology (J.K., T.B.-B., C.M., J.F.K., C.Z., T.H.)
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  • ORCID record for J. Kaesmacher
T. Boeckh-Behrens
aFrom the Departments of Neuroradiology (J.K., T.B.-B., C.M., J.F.K., C.Z., T.H.)
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S. Simon
bNeurology (S.S., L.S., H.P.), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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C. Maegerlein
aFrom the Departments of Neuroradiology (J.K., T.B.-B., C.M., J.F.K., C.Z., T.H.)
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J.F. Kleine
aFrom the Departments of Neuroradiology (J.K., T.B.-B., C.M., J.F.K., C.Z., T.H.)
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C. Zimmer
aFrom the Departments of Neuroradiology (J.K., T.B.-B., C.M., J.F.K., C.Z., T.H.)
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L. Schirmer
bNeurology (S.S., L.S., H.P.), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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H. Poppert
bNeurology (S.S., L.S., H.P.), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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T. Huber
aFrom the Departments of Neuroradiology (J.K., T.B.-B., C.M., J.F.K., C.Z., T.H.)
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    Fig 1.

    DSA images in a lateral projection in a case of initial carotid-T occlusion (A). Dynamic images (delay = 1 second) after successful POS recanalization resulting in 1 proximal (filled arrow) and 1 intermediate embolus (open arrow) due to PTF (B–D).

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    Fig 2.

    DSA images in a lateral projection in a case of initial M1 occlusion (A). Dynamic images (delay = 1 second) after successful recanalization of the POS, resulting in 1 intermediate (open arrow) and 2 distal emboli (filled arrows) due to PTF (B–D).

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    Fig 3.

    Histologic specimens of 2 different clots with H&E staining (magnification ×30) (A and E), segmentation of RBC (red), F/P (purple), WBC (blue), and staining artifacts (brown) for composite quantification (B and F). H&E staining (magnification ×200) (C and G) and NE staining (magnification ×200) (D and H) with accumulation of NE-positive cells marked (asterisks). Clot composition is the following: upper row: 30% RBC, 51% F/P, 19% WBC; NE index 1; lower row: 7% RBC, 84% F/P, 9% WBC, NE index 4.

Tables

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  • Patient characteristics, clot histology, and procedural parameters

    No. or Median with Interquartile Range
    Patients (No.)85
    Male/female (No.)40/45 (47%/53%)
    Age (median) (yr)73 (65–80)
    POS (No.)
        ICA/carotid-T26 (30.6%)
        ACA2 (2.3%)
        MCA57 (67.1%)
    IV rtPA bridging therapy (No.)58 (68%)
    Maneuvers (No.)2 (1–4)
    Procedure time for POS recanalization (min)37 (21–64)
    TICI after POS recanalization (No.)
        11 (1%)
        2a27 (32%)
        2b21 (25%)
        336 (42%)
    Occlusions due to PTF (n = 101)
        Proximal26 (26%)
        Intermediate50 (50%)
        Distal25 (25%)
    Clot histology (fraction in %)
        RBC37 (27–48)
        F/P57 (47–67)
        WBC5 (4–7)
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American Journal of Neuroradiology: 38 (5)
American Journal of Neuroradiology
Vol. 38, Issue 5
1 May 2017
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Cite this article
J. Kaesmacher, T. Boeckh-Behrens, S. Simon, C. Maegerlein, J.F. Kleine, C. Zimmer, L. Schirmer, H. Poppert, T. Huber
Risk of Thrombus Fragmentation during Endovascular Stroke Treatment
American Journal of Neuroradiology May 2017, 38 (5) 991-998; DOI: 10.3174/ajnr.A5105

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Risk of Thrombus Fragmentation during Endovascular Stroke Treatment
J. Kaesmacher, T. Boeckh-Behrens, S. Simon, C. Maegerlein, J.F. Kleine, C. Zimmer, L. Schirmer, H. Poppert, T. Huber
American Journal of Neuroradiology May 2017, 38 (5) 991-998; DOI: 10.3174/ajnr.A5105
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