Author + information
- Hajo Hund1,
- Anouchska Autar1,
- Sharad Ramlal1,
- Daniel Hansen1,
- Geert Lycklama a Nijeholt2,
- Bart Emmer1,
- Aad van der Lugt1,
- Ad van Es1 and
- Heleen van Beusekom3
Multiple randomized controlled trials have demonstrated that mechanical thrombectomy with stent-retrievers (SR) is beneficial for patients with acute ischemic stroke (AIS) caused by thrombotic intracranial large vessel occlusion. However, the mechanisms of interaction between stent and thrombus are largely unknown. We aimed to study the interaction between stent and thrombus following thrombectomy for AIS.
Seven SR were collected directly after thrombectomy. SR, with thrombi entrapped (Fig. 1), were prepared for scanning electron microscopy (SEM) to analyze SR-thrombus interactions and associated thrombus surfaces at all interaction sites1. 94 interaction sites were analyzed by SEM by two independent raters. A Chi-squared test was used for statistical analyses. A p-value <0.05 was considered statistically significant.
SR-thrombus interaction was found to be predominantly active (Fig. 1C, 61±30%) and, to a lesser extent, mechanical (Fig. 1B, 39±30%). A strong correlation was found between interaction type and thrombus surface, with active adhesion predominantly associated with a dense thrombus surface, and mechanical interaction with a loose thrombus surface (p=0.003).
The interaction between stent and thrombus was predominantly active which was associated with a dense fibrin surface. As alteplase, routinely given in these patients, may interfere with active stent-thrombus interaction, its indication should be carefully considered in patients who are candidates for stent based thrombectomy. The small number of stents studied, do indicate that results should be interpreted with caution. 1Neurology. 2017 Jan 10;88(2):216-217
CORONARY: Thrombus / Thrombectomy and Embolic Protection