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Desilles JP, Solo Nomenjanahary M, Consoli A, Ollivier V, Faille D, Bourrienne MC, Hamdani M, Dupont S, Di Meglio L, Escalard S, Maier B, Blanc R, Piotin M, Lapergue B, Ajzenberg N, Vasse M, Mazighi M, Ho-Tin-Noé B, Désilles JP, Mazighi M, Piotin M, Blanc R, Redjem H, Smajda S, Seners P, Escalard S, Delvoye F, Maier B, Hebert S, Ben Maacha M, Hamdani M, Sabben C, Obadia M, Deschildre C, Lapergue B, Consoli A, Rodesch G, Maria F, Coskun O, Lopez D, Bourcier R, Detraz L, Desal H, Roy M, Clavier D, Marnat G, Gariel F, Lucas L, Sibon I, Eugene F, Vannier S, Ferre JC, LeBras A, Raoult H, Paya C, Gauvrit JY, Richard S, Gory B, Barbier C, Vivien D, Touze E, Gauberti M, Blaizot G, Ifergan H, Herbreteau D, Bibi R, Janot K, Charron V, Boulouis G. Impact of COVID-19 on thrombus composition and response to thrombolysis: Insights from a monocentric cohort population of COVID-19 patients with acute ischemic stroke. J Thromb Haemost 2022; 20:919-928. [PMID: 35032088 PMCID: PMC9906142 DOI: 10.1111/jth.15646] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/23/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Resistance to fibrinolysis, levels of procoagulant/antifibrinolytic neutrophil extracellular traps (NETs), and the severity of acute ischemic stroke (AIS) are increased by COVID-19. Whether NETs are components of AIS thrombi from COVID-19 patients and whether COVID-19 impacts the susceptibility of these thrombi to thrombolytic treatments remain unknown, however. OBJECTIVES We aimed to characterize AIS thrombi from COVID-19 patients by immunohistology and to compare their response to thrombolysis to that of AIS thrombi from non-COVID-19 patients. PATIENTS/METHODS For this monocentric cohort study, 14 thrombi from COVID-19 AIS patients and 16 thrombi from non-COVID-19 patients, all recovered by endovascular therapy, were analyzed by immunohistology or subjected to ex vivo thrombolysis by tissue-type plasminogen (tPA)/plasminogen. RESULTS COVID-19 AIS thrombi were rich in neutrophils and contained NETs, but not spike protein. Thrombolysis assays revealed a mean resistance profile to tPA/plasminogen of COVID-19 AIS thrombi similar to that of non-COVID-19 AIS thrombi. The addition of DNase 1 successfully improved thrombolysis by potentiating fibrinolysis irrespective of COVID-19 status. Levels of neutrophil, NETs, and platelet markers in lysis supernatants were comparable between AIS thrombi from non-COVID-19 and COVID-19 patients. CONCLUSIONS These results show that COVID-19 does not impact NETs content or worsen fibrinolysis resistance of AIS thrombi, a therapeutic hurdle that could be overcome by DNase 1 even in the context of SARS-CoV-2 infection.
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Affiliation(s)
- Jean-Philippe Desilles
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France; Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | | | - Arturo Consoli
- Department of Stroke Centre and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - Véronique Ollivier
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France
| | - Dorothée Faille
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France
| | | | - Mylène Hamdani
- Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Sébastien Dupont
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France
| | - Lucas Di Meglio
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France
| | - Simon Escalard
- Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Benjamin Maier
- Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Raphael Blanc
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France; Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Michel Piotin
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France; Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Bertrand Lapergue
- Department of Stroke Centre and Diagnostic and Interventional Neuroradiology, University of Versailles and Saint Quentin en Yvelines, Foch Hospital, Suresnes, France
| | - Nadine Ajzenberg
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France
| | - Marc Vasse
- Biology Department, UMR-S 1176, Foch Hospital, Suresnes, France
| | - Mikael Mazighi
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France; Interventional Neuroradiology Department, Biological Resource Center, Rothschild Foundation Hospital, Paris, France
| | - Benoît Ho-Tin-Noé
- Université de Paris and Université Sorbonne Paris Nord, INSERM, LVTS, Paris, France.
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Freiherr von Seckendorff A, Delvoye F, Levant P, Solo Nomenjanahary M, Ollivier V, Bourrienne MC, Di Meglio L, Piotin M, Escalard S, Maier B, Hebert S, Smajda S, Redjem H, Mazighi M, Blanc R, Ho-Tin-Noé B, Désilles JP. Modeling Large Vessel Occlusion Stroke for the Evaluation of Endovascular Therapy According to Thrombus Composition. Front Neurol 2022; 12:815814. [PMID: 35153990 PMCID: PMC8829452 DOI: 10.3389/fneur.2021.815814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022] Open
Abstract
More than 40% of endovascular therapy (EVT) fail to achieve complete reperfusion of the territory of the occluded artery in patients with acute ischemic stroke (AIS). Understanding factors influencing EVT could help overcome its limitations. Our objective was to study the impact of thrombus cell composition on EVT procedures, using a simulation system for modeling thrombus-induced large vessel occlusion (LVO) in flow conditions. In an open comparative trial, we analyzed the behavior of size-standardized platelet-rich and red blood cells (RBC)-rich thrombi during simulated stent retriever-mediated EVT procedures. Sixteen simulated EVT procedures were performed (8 RBC- vs. 8 platelet-rich thrombi). Platelet-rich thrombi were associated with a higher number of stent retriever passes (p = 0.03) and a longer procedure duration (p = 0.02) compared to RBC-rich thrombi. Conversely, RBC-rich thrombi released more embolic fragments than platelet-rich thrombi (p = 0.004). Both RBC-rich and platelet-rich thrombi underwent drastic compaction after being injected into the in vitro circulation model, and histologic analyses showed that these EVT-retrieved thrombi displayed features comparable to those previously observed in thrombi from patients with AIS patients having LVO, including a marked structural dichotomy between RBC- and platelet-rich areas. Our results show that the injection of in vitro-produced thrombi in artificial cerebrovascular arterial networks is suitable for testing recanalization efficacy and the risk of embolization of EVT devices and strategies in association with thrombus cell composition.
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Affiliation(s)
- Aurélien Freiherr von Seckendorff
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - François Delvoye
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Paul Levant
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Mialitiana Solo Nomenjanahary
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Véronique Ollivier
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Marie-Charlotte Bourrienne
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Lucas Di Meglio
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Simon Escalard
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Benjamin Maier
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Solène Hebert
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Stanislas Smajda
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Hocine Redjem
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Raphael Blanc
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Benoit Ho-Tin-Noé
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Jean-Philippe Désilles
- Interventional Neuroradiology Department, Biological Resource Center, Hôpital Fondation Adolphe de Rothschild, Paris, France
- Université de Paris, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
- *Correspondence: Jean-Philippe Désilles
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Paternotte S, Dercy B, Désilles JP, Sabben C, Boursin P. [Nursing support during thrombolysis in the neurovascular ICU]. Soins 2018; 63:36-40. [PMID: 30213314 DOI: 10.1016/j.soin.2018.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Intravenous thrombolysis is one of two emergency procedures for ischaemic stroke. Its implementation requires fine coordination of the healthcare team and must be adapted to the local context of each hospital and sector. International good clinical practice guidelines are available to support team organisation.
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Affiliation(s)
- Sophie Paternotte
- Unité de soins intensifs neurovasculaires, Fondation ophtalmologique Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France.
| | - Burty Dercy
- Unité de soins intensifs neurovasculaires, Fondation ophtalmologique Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France
| | - Jean-Philippe Désilles
- Neuroradiologie interventionnelle, Fondation ophtalmologique Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France
| | - Candice Sabben
- Unité de soins intensifs neurovasculaires, Fondation ophtalmologique Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France
| | - Perrine Boursin
- Neuroradiologie interventionnelle, Fondation ophtalmologique Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France
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