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Donnerstag F, Werlein C, Götz F, Fares OA, Raab P, Iglesias EC, Lanfermann H, Wattjes MP, Jonigk D. Adhesion of vessel wall to stentriever during combined technique for mechanical thrombectomy in acute ischemic stroke: A histomorphological study. Interv Neuroradiol 2023:15910199231216764. [PMID: 38056004 DOI: 10.1177/15910199231216764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
PURPOSE Detection of vessel wall tissue in thrombus material in patients with ischemic stroke is judged as vascular injury. So far, several studies investigated components of the free clots after mechanical thrombectomy. The aim of this retrospective study was to investigate the involvement and role of the stentriever in vessel wall injury by analysis of the composition of adherent tissue to the stentriever during combined aspiration thrombectomy with stentriever. METHODS Stentriever with adherent tissue and free clots in aspiration samples from patients undergoing mechanical thrombectomy (aspiration plus stentriever) were separately assessed for the occurrence of parts of vascular tissue together with clinical and interventional data as well as clinical outcome data. Specimens were analyzed histomorphologically and immunohistochemically. Findings, focused on parts of vessel wall were reported together with clinical data. RESULTS Specimens from 21 identified patients were available. Parts of the vessel wall were detected in 7 out 21 (33%) samples. All specimens revealed fresh thrombus material without signs of organization or atheromatous tissue. In 90% of patients mTICI was greater than 2b without signs of secondary vessel injury. No vascular tissue was found in free clots of the aspiration samples. CONCLUSION The examination of adherent tissue to the stentriever instead of the examination of free clots may affect the number of detected parts of vessel wall. Further studies in combination with vessel wall imaging may elucidate the origin of remnants of vessel wall.
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Affiliation(s)
- Frank Donnerstag
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | | | - Friedrich Götz
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Omar Abu Fares
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Peter Raab
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | | | - Heinrich Lanfermann
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Mike P Wattjes
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Danny Jonigk
- Institute for Pathology, Hannover Medical School, Hannover, Germany
- Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) of the German Center for Lung Research (DZL), Hannover, Germany
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2
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Huang J, Killingsworth MC, Bhaskar SMM. Is Composition of Brain Clot Retrieved by Mechanical Thrombectomy Associated with Stroke Aetiology and Clinical Outcomes in Acute Ischemic Stroke?—A Systematic Review and Meta-Analysis. Neurol Int 2022; 14:748-770. [PMID: 36278687 PMCID: PMC9589969 DOI: 10.3390/neurolint14040063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Brain clots retrieved following endovascular thrombectomy in acute ischemic stroke patients may offer unique opportunities to characterise stroke aetiology and aid stroke decision-making in select groups of patients. However, the evidence around the putative association of clot morphology with stroke aetiology is limited and remains inconclusive. This study aims to perform a systematic review and meta-analysis to delineate the association of brain clot composition with stroke aetiology and post-reperfusion outcomes in patients receiving endovascular thrombectomy. Methods: The authors conducted a systematic literature review and meta-analysis by extracting data from several research databases (MEDLINE/PubMed, Cochrane, and Google Scholar) published since 2010. We used appropriate key search terms to identify clinical studies concerning stroke thrombus composition, aetiology, and clinical outcomes, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: The authors identified 30 articles reporting on the relationship between stroke thrombus composition or morphology and aetiology, imaging, or clinical outcomes, of which 21 were included in the meta-analysis. The study found that strokes of cardioembolic origin (SMD = 0.388; 95% CI, 0.032–0.745) and cryptogenic origin (SMD = 0.468; 95% CI, 0.172–0.765) had significantly higher fibrin content than strokes of non-cardioembolic origin. Large artery atherosclerosis strokes had significantly lower fibrin content than cardioembolic (SMD = 0.552; 95% CI, 0.099–1.004) or cryptogenic (SMD = 0.455; 95% CI, 0.137–0.774) strokes. Greater red blood cell content was also significantly associated with a thrombolysis in cerebral infarction score of 2b–3 (SMD = 0.450; 95% CI, 0.177–0.722), and a positive hyperdense middle cerebral artery sign (SMD = 0.827; 95% CI, 0.472–1.183). No significant associations were found between red blood cell, platelet, or white blood cell content and aetiology, or between clot composition and bridging thrombolysis. Conclusions: This meta-analysis found that fibrin composition is significantly higher in strokes of cardioembolic and cryptogenic origin, and that red blood cell content is positively associated with the hyperdense middle cerebral artery sign and better reperfusion outcomes. Important advances to stroke clinical workup can be derived from these findings, in which many aspects of stroke workflow remain to be optimised. As data are still limited in terms of the association of various thrombus components with stroke aetiology as well as a standardised method of analysis, further studies are required to validate these findings to guide their use in clinical decision-making.
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Affiliation(s)
- Joanna Huang
- Global Health Neurology Lab, Sydney, NSW 2000, Australia
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, NSW 2170, Australia
- UNSW Medicine and Health, University of New South Wales (UNSW), South Western Sydney Clinical Campuses, Sydney, NSW 2170, Australia
| | - Murray C. Killingsworth
- UNSW Medicine and Health, University of New South Wales (UNSW), South Western Sydney Clinical Campuses, Sydney, NSW 2170, Australia
- Department of Anatomical Pathology, NSW Health Pathology, Correlative Microscopy Facility, Ingham Institute for Applied Medical Research and Western Sydney University (WSU), Liverpool, NSW 2170, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia
| | - Sonu M. M. Bhaskar
- Global Health Neurology Lab, Sydney, NSW 2000, Australia
- Neurovascular Imaging Laboratory, Ingham Institute for Applied Medical Research, Clinical Sciences Stream, Sydney, NSW 2170, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW 2170, Australia
- Liverpool Hospital & South West Sydney Local Health District (SWSLHD), Department of Neurology & Neurophysiology, Sydney, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Stroke & Neurology Research Group, Sydney, NSW 2170, Australia
- Clinical Sciences Building, 1 Elizabeth St., Liverpool Hospital, Liverpool, NSW 2170, Australia
- Correspondence: ; Tel.:+61-(02)-8738-9179; Fax: +61-(02)-8738-3648
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Johnson JN, Srivatsan A, Chueh J, Arslanian R, Gounis MJ, Puri AS, Srinivasan VM, Chen SR, Burkhardt JK, Kan P. Impact of histological clot composition on preprocedure imaging and mechanical thrombectomy. Brain Circ 2022; 8:87-93. [PMID: 35909711 PMCID: PMC9336592 DOI: 10.4103/bc.bc_81_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION: We studied the relationship of acute ischemic stroke (AIS) large-vessel occlusion clot composition with vessel recanalization and preprocedure imaging. SUBJECTS AND METHODS: Individual clots from AIS patients who underwent mechanical thrombectomy (MT) between September 2016 and September 2018 were examined. Clot composition was analyzed histologically through a trichrome staining and image segmentation, and the area occupied by red blood cells (RBCs), fibrin, or mixed composition was quantified. RESULTS: Forty-three patients (65.4 ± 12.7 years, 39% of females) who underwent 92 retrieval passes (mean 2.14, range 1–6) were included in this study. Fibrin (44%) occupied the greatest area, followed by mixed composition (34%) and RBCs (22%). A stent retriever was deployed in 81% of cases, 20 patients (47%) achieved first-pass efficacy (FPE) (thrombolysis in cerebral infarction [TICI] 2b-3 after first pass), 41 (95%) achieved successful revascularization (TICI 2b-3), and 21 (49%) had good outcome (modified Rankin Scale [mRS] ≤2) at 90 days. Hyperdense artery sign (HAS) on initial computed tomography was correlated with mixed clot composition (P = 0.01) and lack of fibrin content (P = 0.03). In the univariate analysis, FPE was associated with RBC clot area, atrial fibrillation, and occlusion location but not with fibrin clot area, mixed clot area, stroke etiology, thrombectomy technique, distal emboli, or 90-day mRS. In the multivariate analysis, FPE was significantly correlated with low RBC clot area (odd ratio = 0.96, confidence interval [0.92.99], P = 0.034) but not with atrial fibrillation or location. CONCLUSION: Our results suggest that HAS is correlated with mixed clot composition and lower fibrin content and that lower RBC clot composition is associated with FPE in patients undergoing MT.
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Affiliation(s)
- Jeremiah N Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Aditya Srivatsan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Juyu Chueh
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rose Arslanian
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Matthew J Gounis
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Stephen Russell Chen
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
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Patil S, Darcourt J, Messina P, Bozsak F, Cognard C, Doyle K. Characterising acute ischaemic stroke thrombi: insights from histology, imaging and emerging impedance-based technologies. Stroke Vasc Neurol 2022; 7:353-363. [PMID: 35241632 PMCID: PMC9453827 DOI: 10.1136/svn-2021-001038] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 02/02/2022] [Indexed: 12/13/2022] Open
Abstract
Treatment of acute ischaemic stroke (AIS) focuses on rapid recanalisation of the occluded artery. In recent years, advent of mechanical thrombectomy devices and new procedures have accelerated the analysis of thrombi retrieved during the endovascular thrombectomy procedure. Despite ongoing developments and progress in AIS imaging techniques, it is not yet possible to conclude definitively regarding thrombus characteristics that could advise on the probable efficacy of thrombolysis or thrombectomy in advance of treatment. Intraprocedural devices with dignostic capabilities or new clinical imaging approaches are needed for better treatment of AIS patients. In this review, what is known about the composition of the thrombi that cause strokes and the evidence that thrombus composition has an impact on success of acute stroke treatment has been examined. This review also discusses the evidence that AIS thrombus composition varies with aetiology, questioning if suspected aetiology could be a useful indicator to stroke physicians to help decide the best acute course of treatment. Furthermore, this review discusses the evidence that current widely used radiological imaging tools can predict thrombus composition. Further use of new emerging technologies based on bioimpedance, as imaging modalities for diagnosing AIS and new medical device tools for detecting thrombus composition in situ has been introduced. Whether bioimpedance would be beneficial for gaining new insights into in situ thrombus composition that could guide choice of optimum treatment approach is also reviewed.
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Affiliation(s)
- Smita Patil
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
| | | | | | | | | | - Karen Doyle
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland .,Physiology, National University of Ireland Galway, Galway, Ireland
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5
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Krishnan R, Mays W, Elijovich L. Complications of Mechanical Thrombectomy in Acute Ischemic Stroke. Neurology 2021; 97:S115-S125. [PMID: 34785610 DOI: 10.1212/wnl.0000000000012803] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 06/23/2021] [Indexed: 01/01/2023] Open
Abstract
Multiple randomized clinical trials have supported the use of mechanical thrombectomy (MT) as standard of care in the treatment of large vessel occlusion acute ischemic stroke. Optimal outcomes depend not only on early reperfusion therapy but also on post thrombectomy care. Early recognition of post MT complications including reperfusion hemorrhage, cerebral edema and large space occupying infarcts, and access site complications can guide early initiation of lifesaving therapies that can improve neurologic outcomes. Knowledge of common complications and their management is essential for stroke neurologists and critical care providers to ensure optimal outcomes. We present a review of the available literature evaluating the common complications in patients undergoing MT with emphasis on early recognition and management.
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Affiliation(s)
- Rashi Krishnan
- From the Department of Neurology, University of Tennessee Health Science Center, Memphis
| | - William Mays
- From the Department of Neurology, University of Tennessee Health Science Center, Memphis
| | - Lucas Elijovich
- From the Department of Neurology, University of Tennessee Health Science Center, Memphis.
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6
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Staessens S, François O, Brinjikji W, Doyle KM, Vanacker P, Andersson T, De Meyer SF. Studying Stroke Thrombus Composition After Thrombectomy: What Can We Learn? Stroke 2021; 52:3718-3727. [PMID: 34517770 PMCID: PMC8545837 DOI: 10.1161/strokeaha.121.034289] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The composition of ischemic stroke thrombi has gained an increasing amount of interest in recent years. The implementation of endovascular procedures in standard stroke care has granted researchers the unique opportunity to examine patient thrombus material. Increasing evidence indicates that stroke thrombi are complex and heterogenous, consisting of various biochemical (eg, fibrin, von Willebrand Factor, and neutrophil extracellular traps) and cellular (eg, red blood cells, platelets, leukocytes, and bacteria) components. This complex composition may explain therapeutic limitations and also offer novel insights in several aspects of stroke management. Better understanding of thrombus characteristics could, therefore, potentially lead to improvements in the management of patients with stroke. In this review, we provide a comprehensive overview of the lessons learned by examining stroke thrombus composition after endovascular thrombectomy and its potential relevance for thrombectomy success rates, thrombolysis, clinical outcomes, stroke etiology, and radiological imaging.
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Affiliation(s)
- Senna Staessens
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | | | | | - Karen M. Doyle
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Peter Vanacker
- Department of Neurology, AZ Groeninge, Kortrijk, Belgium
- Department of Neurology, University Hospitals Antwerp, Antwerp, Belgium
- Department of Translational Neuroscience, University of Antwerp, Antwerp, Belgium
| | - Tommy Andersson
- Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
- Department of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Simon F. De Meyer
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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7
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Aliena-Valero A, Baixauli-Martín J, Torregrosa G, Tembl JI, Salom JB. Clot Composition Analysis as a Diagnostic Tool to Gain Insight into Ischemic Stroke Etiology: A Systematic Review. J Stroke 2021; 23:327-342. [PMID: 34649378 PMCID: PMC8521257 DOI: 10.5853/jos.2021.02306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/24/2021] [Accepted: 09/02/2021] [Indexed: 12/22/2022] Open
Abstract
Mechanical thrombectomy renders the occluding clot available for analysis. Insights into thrombus composition could help establish the stroke cause. We aimed to investigate the value of clot composition analysis as a complementary diagnostic tool in determining the etiology of large vessel occlusion (LVO) ischemic strokes (International Prospective Register of Systematic Reviews [PROSPERO] registration # CRD42020199436). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we ran searches on Medline (using the PubMed interface) and Web of Science for studies reporting analyses of thrombi retrieved from LVO stroke patients subjected to mechanical thrombectomy (January 1, 2006 to September 21, 2020). The PubMed search was updated weekly up to February 22, 2021. Reference lists of included studies and relevant reviews were hand-searched. From 1,714 identified studies, 134 eligible studies (97 cohort studies, 31 case reports, and six case series) were included in the qualitative synthesis. Physical, histopathological, biological, and microbiological analyses provided information about the gross appearance, mechanical properties, structure, and composition of the thrombi. There were non-unanimous associations of thrombus size, structure, and composition (mainly proportions of fibrin and blood formed elements) with the Trial of Org 10172 in Acute Stroke Treatment (TOAST) etiology and underlying pathologies, and similarities between cryptogenic thrombi and those of known TOAST etiology. Individual thrombus analysis contributed to the diagnosis, mainly in atypical cases. Although cohort studies report an abundance of quantitative rates of main thrombus components, a definite clot signature for accurate diagnosis of stroke etiology is still lacking. Nevertheless, the qualitative examination of the embolus remains an invaluable tool for diagnosing individual cases, particularly regarding atypical stroke causes.
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Affiliation(s)
- Alicia Aliena-Valero
- Joint Cerebrovascular Research Unit, La Fe Health Research Institute, University of Valencia, Valencia, Spain
| | | | - Germán Torregrosa
- Joint Cerebrovascular Research Unit, La Fe Health Research Institute, University of Valencia, Valencia, Spain
| | - José I. Tembl
- Stroke Unit, Neurology Service, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Juan B. Salom
- Joint Cerebrovascular Research Unit, La Fe Health Research Institute, University of Valencia, Valencia, Spain
- Department of Physiology, University of Valencia, Valencia, Spain
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8
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Mereuta OM, Abbasi M, Fitzgerald S, Dai D, Kadirvel R, Hanel RA, Yoo AJ, Almekhlafi MA, Layton KF, Delgado Almandoz JE, Kvamme P, Mendes Pereira V, Jahromi BS, Nogueira RG, Gounis MJ, Patel B, Aghaebrahim A, Sauvageau E, Bhuva P, Soomro J, Demchuk AM, Thacker IC, Kayan Y, Copelan A, Nazari P, Cantrell DR, Haussen DC, Al-Bayati AR, Mohammaden M, Pisani L, Rodrigues GM, Puri AS, Entwistle J, Meves A, Arturo Larco JL, Savastano L, Cloft HJ, Kallmes DF, Doyle KM, Brinjikji W. Histological evaluation of acute ischemic stroke thrombi may indicate the occurrence of vessel wall injury during mechanical thrombectomy. J Neurointerv Surg 2021; 14:356-361. [PMID: 33975922 PMCID: PMC8581068 DOI: 10.1136/neurintsurg-2021-017310] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/26/2021] [Accepted: 04/06/2021] [Indexed: 11/12/2022]
Abstract
Background Several animal studies have demonstrated that mechanical thrombectomy (MT) for acute ischemic stroke (AIS) may cause vessel wall injury (VWI). However, the histological changes in human cerebral arteries following MT are difficult to determine. Objective To investigate the occurrence of VWI during MT by histological and immunohistochemical evaluation of AIS clots. Methods As part of the multicenter STRIP registry, 277 clots from 237 patients were analyzed using Martius Scarlett Blue stain and immunohistochemistry for CD34 (endothelial cells) and smooth muscle actin (smooth muscle cells). Results MT devices used were aspiration catheters (100 cases), stentriever (101 cases), and both (36 cases). VWI was found in 33/277 clots (12%). There was no significant correlation between VWI and MT device. The degree of damage varied from grade I (mild intimal damage, 24 clots), to grade II (relevant intimal and subintimal damage, 3 clots), and III (severe injury, 6 clots). VWI clots contained significantly more erythrocytes (p=0.006*) and less platelets/other (p=0.005*) than non-VWI clots suggesting soft thrombus material. Thrombolysis correlated with a lower rate of VWI (p=0.04*). VWI cases showed a significantly higher number of passes (2 [1–4] vs 1 [1–3], p=0.028*) and poorer recanalization outcome (p=0.01*) than cases without VWI. Conclusions Histological markers of VWI were present in 12% of AIS thrombi, suggesting that VWI might be related to MT. VWI was associated with soft thrombus consistency, higher number of passes and poorer revascularization outcome. There was no significant correlation between VWI and MT device.
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Affiliation(s)
- Oana Madalina Mereuta
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA .,CÚRAM - SFI Research Centre for Medical Devices and Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Mehdi Abbasi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Seán Fitzgerald
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,CÚRAM - SFI Research Centre for Medical Devices and Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ram Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ricardo A Hanel
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Albert J Yoo
- Department of Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, Texas, USA
| | - Mohammed A Almekhlafi
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kennith F Layton
- Department of Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Josser E Delgado Almandoz
- Department of NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Peter Kvamme
- Department of Radiology, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Vitor Mendes Pereira
- Departments of Medical Imaging and Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Babak S Jahromi
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Raul G Nogueira
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Matthew J Gounis
- Department of Radiology, University of Massachusetts Medical School, New England Center for Stroke Research, Worcester, Massachusetts, USA
| | - Biraj Patel
- Departments of Radiology and Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | - Amin Aghaebrahim
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Department of Neurosurgery, Baptist Medical Center, Jacksonville, Florida, USA
| | - Parita Bhuva
- Department of Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, Texas, USA
| | - Jazba Soomro
- Department of Neurointervention, Texas Stroke Institute, Dallas-Fort Worth, Texas, USA
| | - Andrew M Demchuk
- Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ike C Thacker
- Department of Radiology, Baylor University Medical Center, Dallas, Texas, USA
| | - Yasha Kayan
- Department of NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Alexander Copelan
- Department of NeuroInterventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Pouya Nazari
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Donald Robert Cantrell
- Departments of Radiology and Neurosurgery, Northwestern University, Chicago, Illinois, USA
| | - Diogo C Haussen
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Alhamza R Al-Bayati
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Mahmoud Mohammaden
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Leonardo Pisani
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Gabriel Martins Rodrigues
- Department of Neurology, Grady Memorial Hospital, Atlanta, Georgia, USA.,Emory University, Atlanta, Georgia, USA
| | - Ajit S Puri
- Department of Radiology, University of Massachusetts Medical School, New England Center for Stroke Research, Worcester, Massachusetts, USA
| | - John Entwistle
- Departments of Radiology and Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA
| | - Alexander Meves
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jorge L Arturo Larco
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Luis Savastano
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Harry J Cloft
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David F Kallmes
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Karen M Doyle
- CÚRAM - SFI Research Centre for Medical Devices and Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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9
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Liang W, Wang Y, Du Z, Mang J, Wang J. Intraprocedural Angiographic Signs Observed During Endovascular Thrombectomy in Patients With Acute Ischemic Stroke: A Systematic Review. Neurology 2021; 96:1080-1090. [PMID: 33893205 DOI: 10.1212/wnl.0000000000012069] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/25/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In the real-world practice of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), the analysis of intraprocedural angiographic signs (IPASs) still challenges neurointerventionists. This review provides insights into the significance of these subtle changes for predicting underlying etiology, technical feasibility, and patient prognosis, thus promoting the potential real-time application of these signs. METHODS A systematic literature search was conducted using PubMed, Ovid Medline/Embase, and Cochrane. The search focused on studies published between January 1995 and August 2020 that reported findings related to intraprocedural angiographic manifestations in endovascular recanalization therapy for AIS. RESULTS We identified 12 IPASs in 22 studies involving 1,683 patients. The IPASs were assigned into 3 subsets according to their clinical meanings. CONCLUSION The systematic analysis of IPAS in clinical trials and practice will lead to a better understanding of treatment effects, responses, and mechanisms during EVT. Studies of larger cohorts using more robust statistical methods are needed.
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Affiliation(s)
- Wenzhao Liang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
| | - Yimeng Wang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
| | - Zhihua Du
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
| | - Jing Mang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China.
| | - Jun Wang
- From the Department of Neurology, China-Japan Union Hospital of Jilin University (W.L., J.M.), Changchun, Jilin, China; The Third Clinical College of Norman Bethune (Y.W.), Jilin University, Changchun, Jilin, China; and Department of Neurology, Chinese PLA General Hospital (Z.D., J.W.), Changchun, Jilin, China
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Donnerstag F, Götz F, Dadak M, Raab P, Iglesias EC, Werlein C, Lanfermann H, Jonigk D. Interventional stroke treatment - Is it also safe for arteries? Looking at thrombectomy wall damage through clot histology. Interv Neuroradiol 2020; 27:404-410. [PMID: 33269973 DOI: 10.1177/1591019920976673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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.
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Affiliation(s)
- Frank Donnerstag
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Friedrich Götz
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Mete Dadak
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany.,Clinic of Diagnostic and Interventional Radiology and Neuroradiology, St. Vincenz-Hospital, Paderborn, Germany
| | - Peter Raab
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Enrico Calvino Iglesias
- Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) of the German Center for Lung Research (DZL), Hannover, Germany
| | | | - Heinrich Lanfermann
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Danny Jonigk
- Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) of the German Center for Lung Research (DZL), Hannover, Germany.,Institute for Pathology, Hannover Medical School, Hannover, Germany
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11
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Kühn AL, Vardar Z, Kraitem A, King RM, Anagnostakou V, Puri AS, Gounis MJ. Biomechanics and hemodynamics of stent-retrievers. J Cereb Blood Flow Metab 2020; 40:2350-2365. [PMID: 32428424 PMCID: PMC7820689 DOI: 10.1177/0271678x20916002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/29/2022]
Abstract
In 2015, multiple randomized clinical trials showed an unparalleled treatment benefit of stent-retriever thrombectomy as compared to standard medical therapy for the treatment of a large artery occlusion causing acute ischemic stroke. A short time later, the HERMES collaborators presented the patient-level pooled analysis of five randomized clinical trials, establishing class 1, level of evidence A for stent-retriever thrombectomy, in combination with intravenous thrombolysis when indicated to treat ischemic stroke. In the years following, evidence continues to mount for expanded use of this therapy for a broader category of patients. The enabling technology that changed the tide to support endovascular treatment of acute ischemic stroke is the stent-retriever. This review summarizes the history of intra-arterial treatment of stroke, introduces the biomechanics of embolus extraction with stent-retrievers, describes technical aspects of the intervention, provides a description of hemodynamic implications of stent-retriever embolectomy, and proposes future directions for a more comprehensive, multi-modal endovascular approach for the treatment of acute ischemic stroke.
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Affiliation(s)
- Anna Luisa Kühn
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Zeynep Vardar
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Afif Kraitem
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert M King
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Vania Anagnostakou
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Ajit S Puri
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Matthew J Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
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12
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Endovascular Therapy of Acute Ischemic Stroke in Patients with Large-Vessel Occlusion Associated with Active Malignancy. J Stroke Cerebrovasc Dis 2020; 30:105455. [PMID: 33242784 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105455] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE There is limited data on the effectiveness of endovascular therapy (EVT) in stroke patients with active malignancy. In this study, we investigated the outcome of EVT for acute ischemic stroke for patients with active malignancy compared to those without malignancy. METHODS We selected patients who underwent EVT for acute ischemic stroke between January 2015 and July 2019. Patients were divided into two groups, those with active malignancy (oncology group - OG) and those without (non-oncology group, NOG). RESULTS 300 patients were included in this study. There were 19 EVT procedures (18 patients) in the OG and 285 procedures (282 patients) in the NOG. There was no difference in recanalization success rate (mTICI 2b & 3) between the groups: 94.7% versus 80.9% in OG and NOG respectively (p = 0.13). Success rate using the direct aspiration (ADAPT) technique of EVT was not different between compared groups (42.9% versus 67.7%; p = 0.18). However, when using smaller-caliber aspiration devices, ADAPT was less successful in OG (0.0% versus 64.7%, p < 0.05). There was no difference in recanalization success rate of EVT when using a stent-retriever or combined technique. Patients in the OG had a less favorable functional outcome than in the NOG group (mRS 0-2 at 90-days post event: 22.2% versus 48.2%, p < 0.05) CONCLUSION: The technical success rate of EVT in patients with active malignancy is similar to the general population of stroke patients. Interestingly, the success rate of EVT using the ADAPT technique was lower in the OG when using smaller caliber aspiration devices.
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13
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Tuo QZ, Zou JJ, Lei P. Rodent Models of Vascular Cognitive Impairment. J Mol Neurosci 2020; 71:1-12. [DOI: 10.1007/s12031-020-01733-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 10/12/2020] [Indexed: 12/23/2022]
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14
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Pasarikovski CR, Keith J, da Costa L, Ramjist J, Dobashi Y, Black SE, Yang VXD. Optical coherence tomography imaging after endovascular thrombectomy: a novel method for evaluating vascular injury in a swine model. J Neurosurg 2020; 134:870-877. [PMID: 32059182 DOI: 10.3171/2019.12.jns192881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although studies have shown that some degree of iatrogenic endothelial injury occurs during endovascular thrombectomy (EVT), the clinical significance of such injury is uncertain. Furthermore, it is likely that iatrogenic effects such as endothelial denudation, intimal dissection, and tunica media edema will have varying clinical implications. The purpose of this study was to assess the feasibility of endovascular optical coherence tomography (OCT) in quantifying vessel injury in real time after EVT, correlate vessel injury with histological findings, and perform imaging at varying time intervals after EVT to assess the impact of prolonged direct exposure of the vessel to the thrombus. METHODS Yorkshire swine weighing 35-40 kg were selected for use as the animal model, with a total of 9 vessels from 3 swine examined. Thrombectomy was performed using a second-generation stent retriever 1, 3, and 6 hours after thrombus deposition. The presence and degree of denudation of the endothelium, detachment and separation of the layers of the tunic media, hemorrhage within the media, dissection of the vessels, and thrombus within the lumina were assessed using OCT images acquired immediately after EVT. Bland-Altman analysis indicated that these OCT findings were correlated with postmortem histological findings. RESULTS OCT image acquisition was technically successful in all cases. Endothelial denudation was present in 65% ± 16%, 87% ± 8%, and 93% ± 7% of the vessel surface 1, 3, and 6 hours, respectively, after thrombus deposition and subsequent EVT. Residual intraluminal thrombus was present in vessels at all time intervals despite complete angiographic revascularization. Bland-Altman plots showed good agreement between OCT and histological analysis with respect to the degree of endothelial denudation and elevation, separation of the tunica media, and hemorrhage within the media. OCT appears to be more specific than histological analysis in detecting endothelial elevation. CONCLUSIONS OCT is a feasible method that can be used to assess vascular injury after EVT with histological accuracy. Varying degrees of vessel injury occur after EVT, and residual luminal thrombus can be present despite complete angiographic revascularization.
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Affiliation(s)
| | - Julia Keith
- 2Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto
| | - Leodante da Costa
- 3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto
| | - Joel Ramjist
- 3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto
| | - Yuta Dobashi
- 3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto
| | - Sandra E Black
- 4Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto; and.,5Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Victor X D Yang
- 1Division of Neurosurgery, Department of Surgery, University of Toronto.,3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto.,4Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto; and
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15
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Heo JH, Nam HS, Kim YD, Choi JK, Kim BM, Kim DJ, Kwon I. Pathophysiologic and Therapeutic Perspectives Based on Thrombus Histology in Stroke. J Stroke 2020; 22:64-75. [PMID: 32027792 PMCID: PMC7005358 DOI: 10.5853/jos.2019.03440] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/23/2020] [Indexed: 01/04/2023] Open
Abstract
Recent advances in endovascular thrombectomy have enabled the histopathologic analysis of fresh thrombi in patients with acute stroke. Histologic analysis has shown that the thrombus composition is very heterogeneous between patients. However, the distribution pattern of each thrombus component often differs between patients with cardiac thrombi and those with arterial thrombi, and the efficacy of endovascular thrombectomy is different according to the thrombus composition. Furthermore, the thrombus age is related to the efficacy of reperfusion therapy. Recent studies have shown that neutrophils and neutrophil extracellular traps contribute to thrombus formation and resistance to reperfusion therapy. Histologic features of thrombi in patients with stroke may provide some clues to stroke etiology, which is helpful for determining the strategy of stroke prevention. Research on thrombus may also be helpful for improving reperfusion therapy, including the development of new thrombolytic agents.
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Affiliation(s)
- Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Kyo Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Moon Kim
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea.,Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Joon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Il Kwon
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Korea
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16
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Khismatullin RR, Shakirova AZ, Weisel JW, Litvinov RI. Age-Dependent Differential Staining of Fibrin in Blood Clots and Thrombi. BIONANOSCIENCE 2019. [DOI: 10.1007/s12668-019-00701-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Imaging Clot Characteristics in Stroke and its Possible Implication on Treatment. Clin Neuroradiol 2019; 30:27-35. [DOI: 10.1007/s00062-019-00841-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/17/2019] [Indexed: 12/11/2022]
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18
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Pasarikovski CR, Ramjist J, da Costa L, Black SE, Yang V. Optical coherence tomography imaging after endovascular thrombectomy for basilar artery occlusion: report of 3 cases. J Neurosurg 2019; 133:1141-1146. [PMID: 31443067 DOI: 10.3171/2019.5.jns191252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/30/2019] [Indexed: 11/06/2022]
Abstract
Studies evaluating individuals for endothelial injury after endovascular thrombectomy (EVT) have been done by means of retrieved human thrombus, MR vessel-wall imaging, and animal histopathological studies. These techniques have limitations, because MR imaging has insufficient spatial resolution to directly visualize endothelium, and histopathological examinations are performed ex vivo and are unable to provide real-time patterns of injury. The purpose of the current study was to obtain in vivo intraluminal imaging after EVT by using optical coherence tomography (OCT), examining for evidence of endothelial injury in real time.Three consecutive patients with acute basilar artery occlusion underwent OCT imaging immediately after EVT. There were no complications and adequate images were obtained for all patients. Anatomical features of the vessel wall were discernible, including intima, media, adventitia, and internal/external elastic lamina. Basilar artery thick concentric plaque fibrosis was present, causing outward remodeling and loss of the internal/external lamina in certain regions. Evidence of significant residual thrombus was also visible, with mostly red thrombus present despite complete angiographic revascularization. The residual thrombus was not visible on CT, MR, or cerebral angiography and could certainly cause ongoing function-limiting strokes with occlusion of adjacent vital basilar perforators after EVT.
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Affiliation(s)
| | | | - Leodante da Costa
- 3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto
| | - Sandra E Black
- 4Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto
- 5Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; and
| | - Victor Yang
- 1Division of Neurosurgery, Department of Surgery, University of Toronto
- 2Sunnybrook Health Sciences Centre, Toronto
- 3Division of Neurosurgery, Sunnybrook Hospital, University of Toronto
- 6Bioengineering and Biophotonics Laboratory, Toronto, Ontario, Canada
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19
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Bacigaluppi M, Semerano A, Gullotta GS, Strambo D. Insights from thrombi retrieved in stroke due to large vessel occlusion. J Cereb Blood Flow Metab 2019; 39:1433-1451. [PMID: 31213164 PMCID: PMC6681524 DOI: 10.1177/0271678x19856131] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The recent advances of endovascular procedures to treat stroke due to large cerebral vessel occlusion have made it possible to analyze the retrieved thrombus material. Analysis of cerebral thrombi is emerging as a relevant opportunity to complement the diagnostic workup of etiology, to develop new lytic approaches and to optimize the acute treatment of stroke due to large vessel occlusion. Nonetheless, retrieved thrombi are frequently discarded since their informative potential is often neglected and standards are missing. This review provides an overview of the current knowledge and expanding research relating to thrombus composition analysis in large vessel occlusions. We first discuss the heterogeneity of thrombogenic factors that underlie the thrombotic formation in stroke and its implications to identify stroke etiology and thrombus age. Further, we show that understanding structural characteristics of thrombus is pivotal for the development of new-targeted lytic therapies as well as to improve, through thrombus modeling, the development of thrombectomy devices. Finally, we discuss the on-going attempts to identify a signature of thrombus composition indirectly through imaging and peripheral blood biomarkers, which might in future assist treatment decision-making as well as secondary prevention. Thrombus analysis might contribute to the advancement and optimization of personalized stroke treatments.
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Affiliation(s)
- Marco Bacigaluppi
- 1 Neurology and Neuroimmunology Unit, Insititute of Experimental Neurology, San Raffaele Scientific Institute, Milano, Italy
| | - Aurora Semerano
- 1 Neurology and Neuroimmunology Unit, Insititute of Experimental Neurology, San Raffaele Scientific Institute, Milano, Italy
| | - Giorgia Serena Gullotta
- 1 Neurology and Neuroimmunology Unit, Insititute of Experimental Neurology, San Raffaele Scientific Institute, Milano, Italy
| | - Davide Strambo
- 1 Neurology and Neuroimmunology Unit, Insititute of Experimental Neurology, San Raffaele Scientific Institute, Milano, Italy.,2 Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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20
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Girdhar G, Epstein E, Nguyen K, Gregg C, Kumar T, Wainwright J, Liu AY, Linfante I. Longer 6-mm Diameter Stent Retrievers Are Effective for Achieving Higher First Pass Success with Fibrin-Rich Clots. INTERVENTIONAL NEUROLOGY 2019; 8:187-195. [PMID: 32508901 DOI: 10.1159/000499974] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 03/28/2019] [Indexed: 11/19/2022]
Abstract
First pass success (FPS) can be defined as in vitro retrieval of clot in a single pass during mechanical thrombectomy (MT) for acute large vessel occlusion (LVO). Despite advancements in MT technology, retrieval of fibrin-rich clots remains a challenge. Therefore, the effect of stent retriever length on FPS for fibrin-rich clots was investigated by using SolitaireTM 6 × 40 versus 6 × 30 mm devices with a balloon guide catheter (BGC) or distal access catheter (DAC) and sheath, in an in vitro model of anterior circulation neurovascular anatomy. Additionally, vascular safety of the SolitaireTM 6 × 40 versus 6 × 30 mm devices was evaluated in a porcine model for differences in: luminal thrombus, inflammation, endothelial coverage, fibrin deposits, smooth muscle cell loss, elastic lamina and adventitia disruption, intimal hyperplasia, and lumen reduction, at 0, 30, and 90 days post-treatment. In vitro overall FPS was measured as: SolitaireTM 6 × 40 (95%) and SolitaireTM 6 × 30 (67%). FPS for clot location in middle cerebral artery was: (a) BGC (6 × 40 mm: 100%; 6 × 30 mm: 100%; n = 8); (b) DAC with 088 sheath (6 × 40 mm: 83%; 6 × 30 mm: 33%; n = 12). FPS for clot location in internal carotid artery was: (a) BGC (6 × 40 mm: 100%; 6 × 30 mm: 80%; n = 11); (b) DAC with 088 sheath (6 × 40 mm: 100%; 6 × 30 mm: 67%; n = 10). Stent length had a significant effect (Fisher's exact test; p < 0.05) on FPS. In vivo evaluation in the porcine model showed no difference in vascular safety parameters between the SolitaireTM 6 × 40 and 6 × 30 mm devices (p > 0.05) at all time points in the study. Longer stent retrievers may be safe and effective in improving FPS for fibrin-rich clots in in vitro and in vivo models of LVO.
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Affiliation(s)
- Gaurav Girdhar
- Department of R&D, Neurovascular, Medtronic, Irvine, California, USA
| | - Evan Epstein
- Department of R&D, Neurovascular, Medtronic, Irvine, California, USA
| | - Kevin Nguyen
- Department of R&D, Neurovascular, Medtronic, Irvine, California, USA
| | - Chelsea Gregg
- Department of R&D, Neurovascular, Medtronic, Irvine, California, USA
| | - Tejashri Kumar
- Department of R&D, Neurovascular, Medtronic, Irvine, California, USA
| | - John Wainwright
- Department of R&D, Neurovascular, Medtronic, Irvine, California, USA
| | - Amon Y Liu
- AYL Consulting LLC, Redwood City, California, USA
| | - Italo Linfante
- Interventional Neuroradiology and Endovascular Neurosurgery, Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, Florida, USA
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21
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Predictors of Unexpected Early Reocclusion After Successful Mechanical Thrombectomy in Acute Ischemic Stroke Patients. Stroke 2018; 49:2643-2651. [DOI: 10.1161/strokeaha.118.021685] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Funatsu N, Hayakawa M, Hashimoto T, Yamagami H, Satow T, Takahashi JC, Koga M, Nagatsuka K, Ishibashi-Ueda H, Iwama T, Toyoda K. Vascular wall components in thrombi obtained by acute stroke thrombectomy: clinical significance and related factors. J Neurointerv Surg 2018; 11:232-236. [DOI: 10.1136/neurintsurg-2018-014041] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/15/2018] [Accepted: 07/21/2018] [Indexed: 11/03/2022]
Abstract
Background and purposeVascular wall components (VWCs) are sometimes identified as collagen fibers in specimens retrieved by thrombectomy from acute stroke patients. However, their clinical significance and associated factors remain unclear. The purpose of this study was to clarify the factors associated with VWCs in retrieved thrombi.MethodsConsecutive acute stroke patients treated endovascularly using the Penumbra aspiration catheter or stent retrievers (SRs) at our institute from November 2013 to April 2016 were retrospectively reviewed, and the retrieved thrombi were evaluated histopathologically. VWCs were defined as banded collagen fibers with a distinct boundary observed at the rim or outside of the retrieved thrombi. Factors associated with the presence of VWCs were studied.ResultsA total of 150 specimens (76 specimens retrieved by the Penumbra, 74 by SRs) from 101 patients (47 women, age 74.9±11.1 years) were investigated. Applied thrombectomy devices were aspiration catheters in 42 patients, SRs in 21 patients, and both in 38 patients. VWCs were observed in 24 specimens (16%) from 22 patients. A low proportion of erythrocyte components (41.7±24.8% vs 55.0±26.3%, P=0.01), a high frequency of the devices reaching the M2/P2 (75% vs 50%, P=0.02), and a high number of device passages (P for trend=0.02) were associated with VWC positive thrombi. Successful recanalization (Treatment in Cerebral Ischemia ≥2b) tended to be less frequent in patients with VWC positive thrombi than in those without (73% vs 89%, P=0.06).ConclusionsThe histopathology of occlusive thrombi, arterial sites where devices reached, and number of device passages, might affect the presence of VWCs in retrieved thrombi.
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23
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Yamaguchi S, Hamabe J, Horie N, Yamashita A, Irie J, Tokuda Y, Mutsukura K, Yagi N, Suyama K. Iatrogenic Removal of the Intima in the Middle Cerebral Artery by a Stent Retriever: A Report of Two Cases. World Neurosurg 2018; 118:203-208. [PMID: 30048785 DOI: 10.1016/j.wneu.2018.07.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/13/2018] [Accepted: 07/14/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Mechanical thrombectomy improves functional outcomes in patients with acute ischemic stroke. However, stent retrievers have the risk of vascular damage. CASE DESCRIPTION We present 2 cases of patients with acute internal carotid artery occlusion who experienced removal of the intima by a stent retriever. In both patients, a 6 × 30-mm Solitaire stent was fully deployed from the M2 portion and slowly withdrawn. White membranes were retrieved outside the strut in both patients. Histopathologic examination showed that one membrane consisted of thickened intima and internal elastic lamina and the other consisted of calcified intima and internal elastic lamina. One patient who suffered embolic stroke experienced recurrent infarction within 24 hours after operation, and the damaged vessel was occluded on magnetic resonance angiography 21 days after stroke. In another patient with carotid artery dissection, the damaged vessel showed asymptomatic stenosis on magnetic resonance angiography 90 days after stroke. Arteries with both atherosclerosis and vessel dissection may be vulnerable to high radial expansion force. CONCLUSIONS Full deployment of a relatively large-sized stent into a vulnerable vessel may cause vessel dissection after removal of the intima. Appropriate material selection and treatment strategy while considering stroke etiology and the occlusion site are important to prevent vessel damage.
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Affiliation(s)
- Susumu Yamaguchi
- Department of Neurosurgery, Nagasaki Harbor Medical Center, Nagasaki, Japan.
| | - Junpei Hamabe
- Department of Neurology and Strokology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Aya Yamashita
- Department of Neurology and Strokology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Junji Irie
- Department of Pathology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Yoshihiro Tokuda
- Department of Neurology and Strokology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Kazuo Mutsukura
- Department of Neurology and Strokology, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Nobuhiro Yagi
- Department of Neurosurgery, Nagasaki Harbor Medical Center, Nagasaki, Japan
| | - Kazuhiko Suyama
- Department of Neurosurgery, Nagasaki Harbor Medical Center, Nagasaki, Japan
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Prognostic Role of Microembolic Signals After Endovascular Treatment in Anterior Circulation Ischemic Stroke Patients. World Neurosurg 2018; 110:e882-e889. [DOI: 10.1016/j.wneu.2017.11.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 11/22/2022]
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Baracchini C, Farina F, Soso M, Viaro F, Favaretto S, Palmieri A, Kulyk C, Ballotta E, Nico L, Cester G, Causin F. Stentriever Thrombectomy Failure: A Challenge in Stroke Management. World Neurosurg 2017; 103:57-64. [DOI: 10.1016/j.wneu.2017.03.070] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 11/29/2022]
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Lee JS, Hong JM, Kim JS. Diagnostic and Therapeutic Strategies for Acute Intracranial Atherosclerosis-related Occlusions. J Stroke 2017; 19:143-151. [PMID: 28592778 PMCID: PMC5466291 DOI: 10.5853/jos.2017.00626] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 05/22/2017] [Accepted: 05/26/2017] [Indexed: 12/16/2022] Open
Abstract
Intracranial atherosclerosis-related occlusion (ICAS-O) is frequently encountered at the time of endovascular revascularization treatment (ERT), especially in Asian countries. However, because baseline angiographic findings are similar between ICAS-O and embolism-related occlusion (EMB-O), it is difficult to differentiate the etiologies before the ERT procedure. Moreover, despite successful randomized trials on ERT, results from studies examining the optimal treatment protocol in ICAS-O patients remain unclear. In this review, we describe the clinical and imaging factors that may possibly differentiate ICAS-O from EMB-O. We will also discuss some current hurdles for treating ICAS-O in the hyperacute period and suggest the optimal ERT strategy for ICAS-O patients.
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Affiliation(s)
- Jin Soo Lee
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, Korea
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Huang S, Shekhar H, Holland CK. Comparative lytic efficacy of rt-PA and ultrasound in porcine versus human clots. PLoS One 2017; 12:e0177786. [PMID: 28545055 PMCID: PMC5435301 DOI: 10.1371/journal.pone.0177786] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/03/2017] [Indexed: 01/19/2023] Open
Abstract
Introduction Porcine thrombi are employed routinely in preclinical models of ischemic stroke. In this study, we examined the differential lytic susceptibility of porcine and human whole blood clots with and without the use of microbubbles and ultrasound (US) as an adjuvant. Materials and methods An in vitro system equipped with time-lapse microscopy was used to evaluate recombinant tissue-plasminogen activator (rt-PA) lysis of porcine and human clots in the same species or cross species plasma. Human and porcine whole blood clots were treated with rt-PA and an echo contrast agent, Definity®, and exposed to intermittent 120 kHz US. Results and conclusions The rt-PA lytic efficacy observed for porcine clots in porcine plasma was 22 times lower than for human clots in human plasma reported previously. Further, porcine clots did not exhibit increased lysis with adjuvant Definity® and US exposure. However, the rt-PA lytic susceptibility of the porcine clots in human plasma was similar to that of human clots in human plasma. Human clots perfused with porcine plasma did not respond to rt-PA, but adjuvant use of Definity® and US enhanced lysis. These results reveal considerable differences in lytic susceptibility of porcine clots and human clots to rt-PA. The use of porcine clot models to test new human thrombolytic therapies may necessitate modulation of coagulation and thrombolytic factors to reflect human hemostasis accurately.
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Affiliation(s)
- Shenwen Huang
- Department of Biomedical, Chemical, & Environmental Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, Ohio, United States of America
- * E-mail:
| | - Himanshu Shekhar
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Christy K. Holland
- Department of Biomedical, Chemical, & Environmental Engineering, College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, Ohio, United States of America
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
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Intraprocedural Thrombus Fragmentation During Interventional Stroke Treatment: A Comparison of Direct Thrombus Aspiration and Stent Retriever Thrombectomy. Cardiovasc Intervent Radiol 2017; 40:987-993. [DOI: 10.1007/s00270-017-1614-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 02/26/2017] [Indexed: 11/26/2022]
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Renú A, Laredo C, Lopez-Rueda A, Llull L, Tudela R, San-Roman L, Urra X, Blasco J, Macho J, Oleaga L, Chamorro A, Amaro S. Vessel Wall Enhancement and Blood–Cerebrospinal Fluid Barrier Disruption After Mechanical Thrombectomy in Acute Ischemic Stroke. Stroke 2017; 48:651-657. [DOI: 10.1161/strokeaha.116.015648] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/22/2016] [Accepted: 12/19/2016] [Indexed: 01/23/2023]
Abstract
Background and Purpose—
Less than half of acute ischemic stroke patients treated with mechanical thrombectomy obtain permanent clinical benefits. Consequently, there is an urgent need to identify mechanisms implicated in the limited efficacy of early reperfusion. We evaluated the predictors and prognostic significance of vessel wall permeability impairment and its association with blood–cerebrospinal fluid barrier (BCSFB) disruption after acute stroke treated with thrombectomy.
Methods—
A prospective cohort of acute stroke patients treated with stent retrievers was analyzed. Vessel wall permeability impairment was identified as gadolinium vessel wall enhancement (GVE) in a 24- to 48-hour follow-up contrast-enhanced magnetic resonance imaging, and severe BCSFB disruption was defined as subarachnoid hemorrhage or gadolinium sulcal enhancement (present across >10 slices). Infarct volume was evaluated in follow-up magnetic resonance imaging, and clinical outcome was evaluated with the modified Rankin Scale at day 90.
Results—
A total of 60 patients (median National Institutes of Health Stroke Scale score, 18) were analyzed, of whom 28 (47%) received intravenous alteplase before mechanical thrombectomy. Overall, 34 (57%) patients had GVE and 27 (45%) had severe BCSFB disruption. GVE was significantly associated with alteplase use before thrombectomy and with more stent retriever passes, along with the presence of severe BCSFB disruption. GVE was associated with poor clinical outcome, and both GVE and severe BCSFB disruption were associated with increased final infarct volume.
Conclusions—
These findings may support the clinical relevance of direct vessel damage and BCSFB disruption after acute stroke and reinforce the need for further improvements in reperfusion strategies. Further validation in larger cohorts of patients is warranted.
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Affiliation(s)
- Arturo Renú
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Carlos Laredo
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Antonio Lopez-Rueda
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Laura Llull
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Raúl Tudela
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Luis San-Roman
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Xabier Urra
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Jordi Blasco
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Juan Macho
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Laura Oleaga
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Angel Chamorro
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
| | - Sergio Amaro
- From the Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., C.L., L.L., X.U., A.C., S.A.); Radiology Department, Hospital Clinic, Barcelona, Spain (A.L.-R., L.S.-R., J.B., J.M., L.O.); and CIBER de Bioingeniería, Biomateriales y Nanomedicina, Group of Biomedical Imaging of the University of Barcelona, Spain (R.T.)
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Shi L, Cao HM, Li Y, Xu SX, Zhang Y, Zhang Y, Jin ZF. Electroacupuncture improves neurovascular unit reconstruction by promoting collateral circulation and angiogenesis. Neural Regen Res 2017; 12:2000-2006. [PMID: 29323038 PMCID: PMC5784347 DOI: 10.4103/1673-5374.221156] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Acupuncture at Shuigou (GV26) shows good clinical efficacy for treating stroke, but its mechanism remains poorly understood. In this study, a cerebral infarction model of ischemia/reperfusion injury received electroacupuncture at GV26 (15 Hz and 1 mA, continuous wave [biphasic pulses], for 5 minutes). Electroacupuncture effectively promoted regional cerebral blood flow on the infarct and non-infarct sides, increased infarct lesions, lectin, and number of blood vessels, upregulated von Willebrand factor and cell proliferation marker Ki67 expression, and diminished neurological severity score. These findings confirm that electroacupuncture at GV26 promotes establishment of collateral circulation and angiogenesis, and improves neurological function.
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Affiliation(s)
- Lei Shi
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hong-Mei Cao
- National Engineering Research Center for Beijing Biochip Technology, Beijing, China
| | - Ying Li
- Shaanxi University of Chinese Medicine, Xianyang, Shaanxi Province, China
| | - Shi-Xin Xu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yan Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yang Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhe-Feng Jin
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Dargazanli C, Rigau V, Eker O, Riquelme Bareiro C, Machi P, Gascou G, Arquizan C, Ayrignac X, Mourand I, Corlobé A, Lobotesis K, Molinari N, Costes V, Bonafé A, Costalat V. High CD3+ Cells in Intracranial Thrombi Represent a Biomarker of Atherothrombotic Stroke. PLoS One 2016; 11:e0154945. [PMID: 27152622 PMCID: PMC4859469 DOI: 10.1371/journal.pone.0154945] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/13/2016] [Indexed: 12/26/2022] Open
Abstract
Background and Purpose Approximately 30% of strokes are cryptogenic despite an exhaustive in-hospital work-up. Analysis of clot composition following endovascular treatment could provide insight into stroke etiology. T-cells already have been shown to be a major component of vulnerable atherosclerotic carotid lesions. We therefore hypothesize that T-cell content in intracranial thrombi may also be a biomarker of atherothrombotic origin. Materials and Methods We histopathologically investigated 54 consecutive thrombi retrieved after mechanical thrombectomy in acute stroke patients. First, thrombi were classified as fibrin-dominant, erythrocyte-dominant or mixed pattern. We then performed quantitative analysis of CD3+ cells on immunohistochemically-stained thrombi and compared T-cell content between “atherothrombotic”, “cardioembolism” and “other causes” stroke subtypes. Results Fourteen (26%) thrombi were defined as fibrin-dominant, 15 (28%) as erythrocyte-dominant, 25 (46%) as mixed. The stroke cause was defined as “atherothrombotic” in 10 (18.5%), “cardioembolism” in 25 (46.3%), and “other causes” in 19 (35.2%). Number of T-cells was significantly higher in thrombi from the “atherothrombotic” group (53.60 ± 28.78) than in the other causes (21.77 ± 18.31; p<0.0005) or the “cardioembolism” group (20.08 ± 15.66; p<0.0003). Conclusions The CD3+ T-cell count in intracranial thrombi was significantly higher in “atherothrombotic” origin strokes compared to all other causes. Thrombi with high content of CD3+ cells are more likely to originate from an atherosclerotic plaque.
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Affiliation(s)
- Cyril Dargazanli
- Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
- * E-mail:
| | - Valérie Rigau
- Department of Pathology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Omer Eker
- Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Carlos Riquelme Bareiro
- Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Paolo Machi
- Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Grégory Gascou
- Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Caroline Arquizan
- Department of Neurology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Xavier Ayrignac
- Department of Neurology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Isabelle Mourand
- Department of Neurology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Astrid Corlobé
- Department of Neurology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Kyriakos Lobotesis
- Department of Imaging, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Nicolas Molinari
- IMAG UMR 5149, University of Montpellier, School of Pharmacy, Montpellier University Hospital Center, Colombière Hospital, Montpellier, France
| | - Valérie Costes
- Department of Pathology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Alain Bonafé
- Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
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Immunohistochemical Analysis of Cerebral Thrombi Retrieved by Mechanical Thrombectomy from Patients with Acute Ischemic Stroke. Int J Mol Sci 2016; 17:298. [PMID: 26927082 PMCID: PMC4813162 DOI: 10.3390/ijms17030298] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/17/2016] [Accepted: 02/17/2016] [Indexed: 12/21/2022] Open
Abstract
Mechanical thrombectomy is a novel treatment option for patients with acute ischemic stroke (AIS). Only a few studies have previously suggested strategies to categorize retrieved clots according to their histologic composition. However, these reports did not analyze potential biomarkers that are of importance in stroke-related inflammation. We therefore histopathologically investigated 37 intracerebral thrombi mechanically retrieved from patients with AIS, and focused on the composition of immune cells and platelets. We also conducted correlation analyses of distinctive morphologic patterns (erythrocytic, serpentine, layered, red, white, mixed appearance) with clinical parameters. Most T cells and monocytes were detected in erythrocytic and red clots, in which the distribution of these cells was random. In contrast, von Willebrand factor (vWF)-positive areas co-localized with regions of fibrin and collagen. While clots with huge amounts of vWF seem to be associated with a high National Institute of Health Stroke Scale score at admission, histologic findings could not predict the clinical outcome at discharge. In summary, we provide the first histologic description of mechanically retrieved intracerebral thrombi regarding biomarkers relevant for inflammation in ischemic stroke.
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Kallenberg K, Solymosi L, Taschner CA, Berkefeld J, Schlamann M, Jansen O, Arnold S, Tomandl B, Knauth M, Turowski B. Endovascular stroke therapy with the Aperio thrombectomy device. J Neurointerv Surg 2015. [PMID: 26220408 DOI: 10.1136/neurintsurg-2015-011678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The pharmaceutical therapy for acute ischemic stroke has shortcomings in reopening large vessels and dissolving long thrombi, and endovascular treatment has been found to provide added value. The Aperio thrombectomy device showed promising results in an experimental study. The purpose of this study was to evaluate the device clinically. METHODS 119 patients with acute stroke were treated in nine centers using the Aperio thrombectomy device. Target vessel, diameter, thrombus length, procedure time, recanalization, number of deployments, additional use of anticoagulants, complications, and the use of additional devices were assessed. RESULTS The median thrombus length was 15 mm (range 1.5-20 mm) and the average time from device insertion to recanalization was 30 min (range 5-120 min). Blood flow restoration (Thrombolysis In Cerebral Infarction (TICI) 2-3) was achieved in 85%. In the majority of cases complete clot removal was achieved (TICI 0, 12%; TICI 1, 2%; TICI 2a, 14%; TICI 2b, 18%; TICI 3, 53%). The median number of deployments was 2 (range 1-6). Twelve procedural complications (10%) occurred. CONCLUSIONS The Aperio thrombectomy device seems to be an effective and adequately safe tool for reopening occluded cerebral arteries in the setting of acute stroke.
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Affiliation(s)
- Kai Kallenberg
- Institute for Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Laszlo Solymosi
- Department of Neuroradiology, University Würzburg, Würzburg, Germany
| | - Christian A Taschner
- Department of Neuroradiology, University Medical Center Freiburg, Freiburg, Germany
| | - Joachim Berkefeld
- Institute for Neuroradiology, University Medical Center Frankfurt, J W Goethe-University Frankfurt, Frankfurt, Germany
| | - Marc Schlamann
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, UKSH Campus Kiel, Kiel, Germany
| | - Sebastian Arnold
- Institute for Diagnostic and Interventional Radiology, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Germany
| | - Bernd Tomandl
- Clinic for Radiology and Neuroradiology, Klinikum Christophsbad, Göppingen, Germany
| | - Michael Knauth
- Institute for Diagnostic and Interventional Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Bernd Turowski
- Section of Neuroradiology, Institute for Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
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Wainwright JM, Jahan R. Solitaire FR revascularization device 4×40: safety study and effectiveness in preclinical models. J Neurointerv Surg 2015; 8:710-3. [PMID: 26101268 DOI: 10.1136/neurintsurg-2015-011856] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/02/2015] [Indexed: 11/04/2022]
Abstract
Recent randomized clinical trials have shown the benefit of stent retrievers for endovascular intervention in patients with acute ischemic stroke. The Solitaire 2 FR 4×40 device was developed to address longer clots as well as procedural difficulties. This study was undertaken to evaluate the safety of the new device in a swine model at 0, 30, and 90 days as well as its in vitro effectiveness. There were no significant differences in the overall animal health, tissue injury, hemorrhagic or thrombogenic events related to device usage. Based on the comparison at multiple time points, the Solitaire 2 4×40 device was similar in safety and usability to the Solitaire 2 4×20 device. Due to the additional length of the device, the Solitaire 2 4×40 device may in fact provide a number of additional technical benefits in the neurothrombectomy treatment of ischemic stroke.
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Affiliation(s)
| | - Reza Jahan
- Department of Interventional Neuroradiology, UCLA Medical Center, Los Angeles, California, USA
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Zhang L, Zhang RL, Jiang Q, Ding G, Chopp M, Zhang ZG. Focal embolic cerebral ischemia in the rat. Nat Protoc 2015; 10:539-47. [PMID: 25741989 DOI: 10.1038/nprot.2015.036] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Animal models of focal cerebral ischemia are well accepted for investigating the pathogenesis and potential treatment strategies for human stroke. Occlusion of the middle cerebral artery (MCA) with an endovascular filament is a widely used model to induce focal cerebral ischemia. However, this model is not amenable to thrombolytic therapies. As thrombolysis with recombinant tissue plasminogen activator (rtPA) is a standard of care within 4.5 h of human stroke onset, suitable animal models that mimic cellular and molecular mechanisms of thrombosis and thrombolysis of stroke are required. By occluding the MCA with a fibrin-rich allogeneic clot, we previously developed an embolic model of MCA occlusion in the rat, which recapitulates the key components of thrombotic development and of thrombolytic therapy of rtPA observed from human ischemic stroke. Here we describe in detail the surgical procedures of our model, including preparing emboli from rat donors. These procedures can be typically completed within ∼30 min, and they are highly adaptable to other strains of rats, as well as mice, in both sexes. Thus, this model provides a powerful tool for translational stroke research.
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Affiliation(s)
- Li Zhang
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Rui Lan Zhang
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Quan Jiang
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Guangliang Ding
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Michael Chopp
- 1] Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA. [2] Department of Physics, Oakland University, Rochester, Michigan, USA
| | - Zheng Gang Zhang
- Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA
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Hsieh K, Verma RK, Schroth G, Gratz PP, Kellner-Weldon F, Gralla J, Zubler C, Mordasini P, Jung S, Mattle HP, El-Koussy M. Multimodal 3 Tesla MRI Confirms Intact Arterial Wall in Acute Stroke Patients After Stent-Retriever Thrombectomy. Stroke 2014; 45:3430-2. [DOI: 10.1161/strokeaha.114.006665] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kety Hsieh
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Rajeev K. Verma
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Gerhard Schroth
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Pascal P. Gratz
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Frauke Kellner-Weldon
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Jan Gralla
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Christoph Zubler
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Pasquale Mordasini
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Simon Jung
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Heinrich P. Mattle
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
| | - Marwan El-Koussy
- From the Department of Diagnostic and Interventional Neuroradiology (K.H., R.K.V., G.S., P.P.G., F.K.-W., J.G., C.Z., P.M., M.E.-K.), and Department of Neurology (S.J., H.P.M.), University Hospital Bern, Switzerland
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Kellert L, Hametner C, Stampfl S. Response to letter regarding article, "endovascular stroke therapy: tirofiban is associated with risk of fatal intracerebral hemorrhage and poor outcome". Stroke 2013; 44:e113. [PMID: 23929751 DOI: 10.1161/strokeaha.113.002354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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