Does prior administration of rtPA influence acute ischemic stroke clot composition? Findings from the analysis of clots retrieved with mechanical thrombectomy from the RESTORE registry.
Bridging-therapy
Mechanical thrombectomy
Stroke
Thrombus histology
Thrombus size
Journal
Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161
Informations de publication
Date de publication:
Apr 2022
Apr 2022
Historique:
received:
22
05
2021
accepted:
15
08
2021
revised:
29
06
2021
pubmed:
21
8
2021
medline:
25
3
2022
entrez:
20
8
2021
Statut:
ppublish
Résumé
There is still much debate whether bridging-therapy [intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MT)] might be beneficial compared to MT alone. We investigated the effect of IVT on size and histological composition of the clots retrieved from patients undergoing bridging-therapy or MT alone. We collected mechanically extracted thrombi from 1000 acute ischemic stroke (AIS) patients included in RESTORE registry. Patients were grouped according to the administration (or not) of IVT before thrombectomy. Gross photos of each clot were taken and Extracted Clot Area (ECA) was measured using ImageJ software. Martius Scarlett Blue stain was used to characterize the main histological clot components [red blood cells (RBCs), fibrin (FIB), platelets/other (PTL)] and Orbit Image Analysis was used for quantification. Additionally, we calculated the area of each main component by multiplying the component percent by ECA. Chi-squared and Kruskal-Wallis tests were used for statistical analysis. 451 patients (45%) were treated with bridging-therapy while 549 (55%) underwent MT alone. When considering only percent histological composition, we did not find any difference in RBC% (P = 0.895), FIB% (P = 0.458) and PTL% (P = 0.905). However, bridging-therapy clots were significantly smaller than MT-alone clots [32.7 (14.8-64.9) versus 36.8 (20.1-79.8) mm Our results suggest that previous IVT administration significantly reduces thrombus size, proportionally releasing all the main histological components.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
There is still much debate whether bridging-therapy [intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MT)] might be beneficial compared to MT alone. We investigated the effect of IVT on size and histological composition of the clots retrieved from patients undergoing bridging-therapy or MT alone.
METHODS
METHODS
We collected mechanically extracted thrombi from 1000 acute ischemic stroke (AIS) patients included in RESTORE registry. Patients were grouped according to the administration (or not) of IVT before thrombectomy. Gross photos of each clot were taken and Extracted Clot Area (ECA) was measured using ImageJ software. Martius Scarlett Blue stain was used to characterize the main histological clot components [red blood cells (RBCs), fibrin (FIB), platelets/other (PTL)] and Orbit Image Analysis was used for quantification. Additionally, we calculated the area of each main component by multiplying the component percent by ECA. Chi-squared and Kruskal-Wallis tests were used for statistical analysis.
RESULTS
RESULTS
451 patients (45%) were treated with bridging-therapy while 549 (55%) underwent MT alone. When considering only percent histological composition, we did not find any difference in RBC% (P = 0.895), FIB% (P = 0.458) and PTL% (P = 0.905). However, bridging-therapy clots were significantly smaller than MT-alone clots [32.7 (14.8-64.9) versus 36.8 (20.1-79.8) mm
CONCLUSIONS
CONCLUSIONS
Our results suggest that previous IVT administration significantly reduces thrombus size, proportionally releasing all the main histological components.
Identifiants
pubmed: 34415423
doi: 10.1007/s00415-021-10758-5
pii: 10.1007/s00415-021-10758-5
pmc: PMC8940807
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1913-1920Subventions
Organisme : Science Foundation Ireland
ID : 13/RC/2073_2
Pays : Ireland
Informations de copyright
© 2021. The Author(s).
Références
Eur Stroke J. 2021 Mar;6(1):I-LXII
pubmed: 33817340
Int J Stroke. 2009 Aug;4(4):267-73
pubmed: 19689755
Stroke. 2021 Jan;52(2):729-734
pubmed: 33467874
N Engl J Med. 2015 Jan 1;372(1):11-20
pubmed: 25517348
N Engl J Med. 2015 Mar 12;372(11):1019-30
pubmed: 25671798
Eur Stroke J. 2021 Sep;6(3):254-261
pubmed: 34746421
J Neurointerv Surg. 2021 Dec;13(12):1111-1116
pubmed: 33298510
Stroke. 2021 Mar;52(3):1131-1142
pubmed: 33563020
PLoS Comput Biol. 2020 Feb 5;16(2):e1007313
pubmed: 32023239
Ann Neurol. 2019 Sep;86(3):395-406
pubmed: 31282044
Am J Physiol. 1987 Nov;253(5 Pt 2):H1069-73
pubmed: 3688251
Stroke. 2018 Jan;49(1):265-269
pubmed: 29212747
J Neurointerv Surg. 2014 Mar;6(2):83-6
pubmed: 23390038
BMC Neurol. 2015 Mar 15;15:35
pubmed: 25885595
N Engl J Med. 2015 Jun 11;372(24):2285-95
pubmed: 25882376
Stroke. 2015 Jul;46(7):1877-82
pubmed: 25967573
Stroke. 2017 Feb;48(2):375-378
pubmed: 28062859
J Neurointerv Surg. 2021 Oct;13(10):906-911
pubmed: 33361274
N Engl J Med. 2015 Mar 12;372(11):1009-18
pubmed: 25671797
JAMA. 2013 Nov 27;310(20):2191-4
pubmed: 24141714
Int J Stroke. 2017 Aug;12(6):606-614
pubmed: 28534706
Lancet Neurol. 2016 Oct;15(11):1138-47
pubmed: 27567239
J Neurointerv Surg. 2018 Jan;10(1):17-21
pubmed: 28062805
J Neurointerv Surg. 2019 Nov;11(11):1145-1149
pubmed: 30952688
J Thromb Thrombolysis. 2021 Feb;51(2):545-551
pubmed: 32936433
J Neurointerv Surg. 2019 Feb 26;:
pubmed: 30808653
Thromb Haemost. 2009 Dec;102(6):1169-75
pubmed: 19967148
Stroke. 2018 Mar;49(3):652-659
pubmed: 29374103
J Stroke Cerebrovasc Dis. 2021 Jan;30(1):105463
pubmed: 33242780
N Engl J Med. 2015 Jun 11;372(24):2296-306
pubmed: 25882510
Stroke. 1993 Jan;24(1):35-41
pubmed: 7678184
J Neurointerv Surg. 2020 Jun;12(6):557-562
pubmed: 31685695
J Neurointerv Surg. 2019 Nov;11(11):1073-1079
pubmed: 31088941
Circ J. 2018 Feb 23;82(3):866-873
pubmed: 29176266
Stroke. 2019 Dec;50(12):e344-e418
pubmed: 31662037
PLoS One. 2019 Dec 5;14(12):e0225841
pubmed: 31805096