Absence of susceptibility vessel sign is associated with aspiration-resistant fibrin/platelet-rich thrombi.
Aspiration
SVS
histology
stent retriever
stroke
thombectomy
thrombus
Journal
International journal of stroke : official journal of the International Stroke Society
ISSN: 1747-4949
Titre abrégé: Int J Stroke
Pays: United States
ID NLM: 101274068
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
pubmed:
14
1
2021
medline:
12
11
2021
entrez:
13
1
2021
Statut:
ppublish
Résumé
The composition of the thrombus influences its retrievability by mechanical thrombectomy. Our study aimed to report on thrombi resistant to aspiration, regarding susceptibility vessel sign and histologic composition. This observational study was based on a prospective database of acute anterior circulation ischemic strokes treated by mechanical thrombectomy. Endovascular first-line strategy was aspiration and in case of failure, combined therapy-rescue was performed. The positivity of susceptibility vessel sign (SVS+) or its negativity (SVS-) was assessed on T2* sequences. The thrombus composition was analyzed with hematoxylin eosin staining. Histological analysis was performed on 102 clots. Thrombi with SVS- were significantly richer in fibrin/platelets, p = 0.04. Out of 210 mechanical thrombectomy, aspiration first pass strategy was performed in 131/210 (62%) patients. Combined therapy-rescue was needed in 37% of aspiration first pass strategy cases ( Our results confirm that SVS- clots are rich in fibrin/platelets and suggest that these "white clots" are less likely to be retrieved by aspiration alone and more often require the use of combined therapy.
Sections du résumé
BACKGROUND
The composition of the thrombus influences its retrievability by mechanical thrombectomy.
PURPOSE
Our study aimed to report on thrombi resistant to aspiration, regarding susceptibility vessel sign and histologic composition.
METHODS
This observational study was based on a prospective database of acute anterior circulation ischemic strokes treated by mechanical thrombectomy. Endovascular first-line strategy was aspiration and in case of failure, combined therapy-rescue was performed. The positivity of susceptibility vessel sign (SVS+) or its negativity (SVS-) was assessed on T2* sequences. The thrombus composition was analyzed with hematoxylin eosin staining.
RESULTS
Histological analysis was performed on 102 clots. Thrombi with SVS- were significantly richer in fibrin/platelets, p = 0.04. Out of 210 mechanical thrombectomy, aspiration first pass strategy was performed in 131/210 (62%) patients. Combined therapy-rescue was needed in 37% of aspiration first pass strategy cases (
CONCLUSIONS
Our results confirm that SVS- clots are rich in fibrin/platelets and suggest that these "white clots" are less likely to be retrieved by aspiration alone and more often require the use of combined therapy.
Identifiants
pubmed: 33435860
doi: 10.1177/1747493020986626
doi:
Substances chimiques
Fibrin
9001-31-4
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM