Yang Liu 1 , Waleed Brinjikji 2,3 , Mehdi Abbasi 2 , Daying Dai 2 , Jorge L Arturo Larco 3 , Sarosh Irfan Madhani 3 , Adnan H Shahid 3 , Oana Madalina Mereuta 2 , Raul G Nogueira 4 , Peter Kvamme 5 , Kennith F Layton 6 , Josser E Delgado Almandoz 7 , Ricardo A Hanel 8 , Vitor Mendes Pereira 9 , Mohammed A Almekhlafi 10 , Albert J Yoo 11 , Babak S Jahromi 12 , Matthew J Gounis 13 , Biraj Patel 14 , Seán Fitzgerald 15 , Karen Doyle 15 , Diogo C Haussen 4 , Alhamza R Al-Bayati 4 , Mahmoud Mohammaden 4 , Leonardo Pisani 4 , Gabriel Martins Rodrigues 4 , Ike C Thacker 6 , Yasha Kayan 7 , Alexander Copelan 7 , Amin Aghaebrahim 8 , Eric Sauvageau 8 , Andrew M Demchuk 10 , Parita Bhuva 11 , Jazba Soomro 11 , Pouya Nazari 12 , Donald Robert Cantrell 12 , Ajit S Puri 13 , John Entwistle 14 , Ramanathan Kadirvel 2 , Harry J Cloft 2,3 , David F Kallmes 2,3 , Luis Savastano 2,3 Show Affiliations »
Abstract
BACKGROUND: Compositional and structural features of retrieved clots by thrombectomy can provide insight into improving the endovascular treatment of ischemic stroke. Currently, histological analysis is limited to quantification of compositions and qualitative description of the clot structure. We hypothesized that heterogeneous clots would be prone to poorer recanalization rates and performed a quantitative analysis to test this hypothesis. METHODS: We collected and did histology on clots retrieved by mechanical thrombectomy from 157 stroke cases (107 achieved first-pass effect (FPE) and 50 did not). Using an in-house algorithm, the scanned images were divided into grids (with sizes of 0.2, 0.3, 0.4, 0.5, and 0.6 mm) and the extent of non-uniformity of RBC distribution was computed using the proposed spatial heterogeneity index (SHI). Finally, we validated the clinical significance of clot heterogeneity using the Mann-Whitney test and an artificial neural network (ANN) model. RESULTS: For cases with FPE, SHI values were smaller (0.033 vs 0.039 for grid size of 0.4 mm, P=0.028) compared with those without. In comparison, the clot composition was not statistically different between those two groups. From the ANN model, clot heterogeneity was the most important factor, followed by fibrin content, thrombectomy techniques, red blood cell content, clot area, platelet content, etiology, and admission of intravenous tissue plasminogen activator (IV-tPA). No statistical difference of clot heterogeneity was found for different etiologies, thrombectomy techniques, and IV-tPA administration. CONCLUSIONS: Clot heterogeneity can affect the clot response to thrombectomy devices and is associated with lower FPE. SHI can be a useful metric to quantify clot heterogeneity. © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
BACKGROUND: Compositional and structural features of retrieved clots by thrombectomy can provide insight into improving the endovascular treatment of ischemic stroke. Currently, histological analysis is limited to quantification of compositions and qualitative description of the clot structure. We hypothesized that heterogeneous clots would be prone to poorer recanalization rates and performed a quantitative analysis to test this hypothesis. METHODS: We collected and did histology on clots retrieved by mechanical thrombectomy from 157 stroke cases (107 achieved first-pass effect (FPE) and 50 did not). Using an in-house algorithm, the scanned images were divided into grids (with sizes of 0.2, 0.3, 0.4, 0.5, and 0.6 mm) and the extent of non-uniformity of RBC distribution was computed using the proposed spatial heterogeneity index (SHI). Finally, we validated the clinical significance of clot heterogeneity using the Mann-Whitney test and an artificial neural network (ANN) model. RESULTS: For cases with FPE, SHI values were smaller (0.033 vs 0.039 for grid size of 0.4 mm, P=0.028) compared with those without. In comparison, the clot composition was not statistically different between those two groups. From the ANN model, clot heterogeneity was the most important factor, followed by fibrin content, thrombectomy techniques, red blood cell content, clot area, platelet content, etiology, and admission of intravenous tissue plasminogen activator (IV-tPA). No statistical difference of clot heterogeneity was found for different etiologies, thrombectomy techniques, and IV-tPA administration. CONCLUSIONS: Clot heterogeneity can affect the clot response to thrombectomy devices and is associated with lower FPE. SHI can be a useful metric to quantify clot heterogeneity. © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
Entities: Chemical
Keywords:
intervention; stroke; technology; thrombectomy
Year: 2021
PMID： 34911736 DOI： 10.1136/neurintsurg-2021-018183
Source DB: PubMed Journal: J Neurointerv Surg ISSN： 1759-8478 Impact factor: 5.836