Histological evaluation of acute ischemic stroke thrombi may indicate the occurrence of vessel wall injury during mechanical thrombectomy

• Type of Material: Article
• Authors: Oana M Mereuta, Mayo Clinic; Mehdi Abbasi, Mayo Clinic; Seán Fitzgerald, Mayo Clinic; Daying Dai, Mayo Clinic; Ram Kadirvel, Mayo Clinic; Ricardo A Hanel, Baptist Medical Center; Albert J Yoo, Texas Stroke Institute; Mohammed A Almekhlafi, University of Calgary; Kennith F Layton, Baylor University; Josser E Delgado Almandoz, Abbott Northwestern Hospital; Peter Kvamme, University of Tennessee Medical Center; Vitor Mendes Pereira, Toronto Western Hospital; Babak S Jahromi, Northwestern University; Raul Nogueira, Emory University; Matthew J Gounis, University of Massachusetts; Biraj Patel, Carilion Clinic; Amin Aghaebrahim, Baptist Medical Center; Eric Sauvageau, Baptist Medical Center; Parita Bhuva, Texas Stroke Institute, Dallas-Fort Worth; Jazba Soomro, Texas Stroke Institute, Dallas-Fort Worth; Andrew M Demchuk, University of Calgary; Ike C Thacker, Baylor University; Yasha Kayan, Abbott Northwestern Hospital; Alexander Copelan, Abbott Northwestern Hospital; Pouya Nazari, Northwestern University; Donald R Cantrell, Northwestern University; Diogo Haussen, Emory University; Alhamza R Al-Bayati, Emory University; Mahmoud Mohammaden, Emory University; Leonardo Pisani, Grady Memorial Hospital; Gabriel M Rodrigues, Grady Memorial Hospital; Ajit S Puri, University of Massachusetts Medical School; John Entwistle, Carilion Clinic; Alexander Meves, Mayo Clinic; Jorge L Arturo Larco, Mayo Clinic; Luis Savastano, Mayo Clinic; Harrry J Cloft, Mayo Clinic; David F Kallmes, Mayo Clinic; Karen M Doyle, National University of Ireland Galway; Waleed Brinjikji, Mayo Clinic
• Language: English
• Date: 2021-05-10
• Publisher: BMJ PUBLISHING GROUP
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/neurintsurg-2021-017310
• Title of Journal or Parent Work: JOURNAL OF NEUROINTERVENTIONAL SURGERY
• Volume: 14
• Issue: 4
• Start Page: 356
• End Page: 361
• Grant/Funding Information: This work was supported by the National Institutes of Health (R01 NS105853) and the European Regional Development Fund and Science Foundation Ireland (grant number 13/RC/2073).
• Keywords: thrombectomy; Life Sciences & Biomedicine; MODEL; DEVICE; Surgery; stroke; Science & Technology; Neuroimaging; Neurosciences & Neurology; vessel wall
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Radiology

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.