Frank Donnerstag1, Friedrich Götz1, Mete Dadak1,2, Peter Raab1, Enrico Calvino Iglesias3, Christopher Werlein4, Heinrich Lanfermann1, Danny Jonigk3,4. 1. Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany. 2. Clinic of Diagnostic and Interventional Radiology and Neuroradiology, St. Vincenz-Hospital, Paderborn, Germany. 3. Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) of the German Center for Lung Research (DZL), Hannover, Germany. 4. Institute for Pathology, Hannover Medical School, Hannover, Germany.
Abstract
BACKGROUND AND PURPOSE: The aim of this study was to investigate whether morphological evidence of intracranial vascular injury can be found in the occluding thrombi of patients with ischemic stroke. METHODS: From 2015 until 2018 specimens of thrombi from patients with large vessel occlusion treated either by stent-assisted aspiration thrombectomy (TE) or by aspiration thrombectomy were prospectively collected. Thrombus specimens were formalin-fixed, paraffin-embedded and stained. Architectural features, presence of parts of vessel wall or atheromatous material, organisation of the thrombi, technique and number of thrombectomy manoeuvers were evaluated. RESULTS: Thrombus specimens from 302 patients were analyzed. 238 (80%) patients were treated with stent-assisted aspiration TE and 64 (20%) patients with aspiration TE only. 286 (95%) had fresh thrombi, 14 (4.6%) showed initial/complete thrombus organisation and multi-staged thrombi were found in 2 (<1%) patients. In 8 patients (2.6%) we found atypical thrombus content after a time interval longer 6 hours after onset and final thrombectomy manoeuvre: 4 with atheromatous material and 4 with parts of a vessel wall. In 1 patient with parts of vessel wall angiographically a dissection was detected. No parts of the vessel wall were found after sole aspiration thrombectomy. CONCLUSIONS: The overall risk of arterial vessel wall injury aspiration thrombectomy was low in our study. Aspiration thrombectomy and the procedure related with a retrieving device together with an ischemia time longer than 6 hours may increase the risk of vessel injury through the thrombectomy procedure. Further investigations are necessary to elucidate the influence of the mentioned aspects.
BACKGROUND AND PURPOSE: The aim of this study was to investigate whether morphological evidence of intracranial vascular injury can be found in the occluding thrombi of patients with ischemic stroke. METHODS: From 2015 until 2018 specimens of thrombi from patients with large vessel occlusion treated either by stent-assisted aspiration thrombectomy (TE) or by aspiration thrombectomy were prospectively collected. Thrombus specimens were formalin-fixed, paraffin-embedded and stained. Architectural features, presence of parts of vessel wall or atheromatous material, organisation of the thrombi, technique and number of thrombectomy manoeuvers were evaluated. RESULTS: Thrombus specimens from 302 patients were analyzed. 238 (80%) patients were treated with stent-assisted aspiration TE and 64 (20%) patients with aspiration TE only. 286 (95%) had fresh thrombi, 14 (4.6%) showed initial/complete thrombus organisation and multi-staged thrombi were found in 2 (<1%) patients. In 8 patients (2.6%) we found atypical thrombus content after a time interval longer 6 hours after onset and final thrombectomy manoeuvre: 4 with atheromatous material and 4 with parts of a vessel wall. In 1 patient with parts of vessel wall angiographically a dissection was detected. No parts of the vessel wall were found after sole aspiration thrombectomy. CONCLUSIONS: The overall risk of arterial vessel wall injury aspiration thrombectomy was low in our study. Aspiration thrombectomy and the procedure related with a retrieving device together with an ischemia time longer than 6 hours may increase the risk of vessel injury through the thrombectomy procedure. Further investigations are necessary to elucidate the influence of the mentioned aspects.
Authors: T Boeckh-Behrens; M Schubert; A Förschler; S Prothmann; K Kreiser; C Zimmer; J Riegger; J Bauer; F Neff; V Kehl; J Pelisek; L Schirmer; M Mehr; H Poppert Journal: Clin Neuroradiol Date: 2014-09-27 Impact factor: 3.649
Authors: B Gory; D Bresson; I Kessler; M L Perrin; A Guillaudeau; K Durand; S Ponsonnard; C Couquet; C Yardin; C Mounayer Journal: AJNR Am J Neuroradiol Date: 2013-03-28 Impact factor: 3.825
Authors: William J Powers; Alejandro A Rabinstein; Teri Ackerson; Opeolu M Adeoye; Nicholas C Bambakidis; Kyra Becker; José Biller; Michael Brown; Bart M Demaerschalk; Brian Hoh; Edward C Jauch; Chelsea S Kidwell; Thabele M Leslie-Mazwi; Bruce Ovbiagele; Phillip A Scott; Kevin N Sheth; Andrew M Southerland; Deborah V Summers; David L Tirschwell Journal: Stroke Date: 2018-01-24 Impact factor: 7.914
Authors: Raul G Nogueira; Ashutosh P Jadhav; Diogo C Haussen; Alain Bonafe; Ronald F Budzik; Parita Bhuva; Dileep R Yavagal; Marc Ribo; Christophe Cognard; Ricardo A Hanel; Cathy A Sila; Ameer E Hassan; Monica Millan; Elad I Levy; Peter Mitchell; Michael Chen; Joey D English; Qaisar A Shah; Frank L Silver; Vitor M Pereira; Brijesh P Mehta; Blaise W Baxter; Michael G Abraham; Pedro Cardona; Erol Veznedaroglu; Frank R Hellinger; Lei Feng; Jawad F Kirmani; Demetrius K Lopes; Brian T Jankowitz; Michael R Frankel; Vincent Costalat; Nirav A Vora; Albert J Yoo; Amer M Malik; Anthony J Furlan; Marta Rubiera; Amin Aghaebrahim; Jean-Marc Olivot; Wondwossen G Tekle; Ryan Shields; Todd Graves; Roger J Lewis; Wade S Smith; David S Liebeskind; Jeffrey L Saver; Tudor G Jovin Journal: N Engl J Med Date: 2017-11-11 Impact factor: 91.245
Authors: Elodie Laridan; Frederik Denorme; Linda Desender; Olivier François; Tommy Andersson; Hans Deckmyn; Karen Vanhoorelbeke; Simon F De Meyer Journal: Ann Neurol Date: 2017-08-11 Impact factor: 10.422
Authors: Götz Thomalla; Bastian Cheng; Martin Ebinger; Qing Hao; Thomas Tourdias; Ona Wu; Jong S Kim; Lorenz Breuer; Oliver C Singer; Steven Warach; Soren Christensen; Andras Treszl; Nils D Forkert; Ivana Galinovic; Michael Rosenkranz; Tobias Engelhorn; Martin Köhrmann; Matthias Endres; Dong-Wha Kang; Vincent Dousset; A Gregory Sorensen; David S Liebeskind; Jochen B Fiebach; Jens Fiehler; Christian Gerloff Journal: Lancet Neurol Date: 2011-10-04 Impact factor: 44.182