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BRIEF COMMUNICATION
Does clot composition impact the First Pass Effect in Mechanical Thrombectomy – preliminary results of a single-center study study
1
Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland
2
Department of Neurology, Medical University of Lublin, Poland
3
Chair and Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Poland
4
Department of Human Physiology, Medical University of Lublin, Poland
5
Department of Radiology, Semmelweis Medical University, Hungary
Corresponding author
Maciej Szmygin
Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland
Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Mechanical thrombectomy is an established therapeutic method for acute ischemic stroke and first pass effect (FPE) constitutes the ultimate goal of endovascular treatment. Aim. To investigate the relationship between the clot composition in acute ischemic stroke (AIS) in patients with large-vessel occlusion and first pass effect of mechanical thrombectomy (MT).
Material and Methods:
Clots from AIS patients who underwent MT were examined histologically and the area occupied by red blood cells (RBCs), white blood cells (WBCs) and fibrin was quantified. The clinical outcome of the procedure was evaluated using modified Rankin Scale (mRS).
Results:
Seventy consecutive patients were included in this prospective study. Demographics, occlusion site, procedural details and clinical outcomes were evaluated. Full recanalization was observed in 54 patients (77.1%) and from this group FPE was achieved in 28 patients. Statistical analysis did not show significant correlation between clot composition and FPE but low RBC clot area was close to significance (P=0.08).
Conclusions:
Despite the lack of statistically significant correlation between clot composition and first pass effect in patients with acute ischemic stroke, we observed that red blood cell rich clots were associated with increased number of thrombectomy passes which supports the notion that clot histology influences recanalization outcomes and shows the need for further studies on this topic.
Mechanical thrombectomy is an established therapeutic method for acute ischemic stroke and first pass effect (FPE) constitutes the ultimate goal of endovascular treatment. Aim. To investigate the relationship between the clot composition in acute ischemic stroke (AIS) in patients with large-vessel occlusion and first pass effect of mechanical thrombectomy (MT).
Material and Methods:
Clots from AIS patients who underwent MT were examined histologically and the area occupied by red blood cells (RBCs), white blood cells (WBCs) and fibrin was quantified. The clinical outcome of the procedure was evaluated using modified Rankin Scale (mRS).
Results:
Seventy consecutive patients were included in this prospective study. Demographics, occlusion site, procedural details and clinical outcomes were evaluated. Full recanalization was observed in 54 patients (77.1%) and from this group FPE was achieved in 28 patients. Statistical analysis did not show significant correlation between clot composition and FPE but low RBC clot area was close to significance (P=0.08).
Conclusions:
Despite the lack of statistically significant correlation between clot composition and first pass effect in patients with acute ischemic stroke, we observed that red blood cell rich clots were associated with increased number of thrombectomy passes which supports the notion that clot histology influences recanalization outcomes and shows the need for further studies on this topic.
FUNDING
Medical University of Lublin, Poland DS grant n. 486
REFERENCES (22)
1.
Campbell BCV, De Silva DA, Macleod MR, et al. Ischaemic stroke. Nat Rev Dis Primers. 2019;5:70.
2.
Salaudeen MA, Bello N, Danraka RN, et al. Understanding the Pathophysiology of Ischemic Stroke: The Basis of Current Therapies and Opportunity for New Ones. Biomolecules. 2024;14:305.
3.
Chalet L, Boutelier T, Christen T, et al. Clinical Imaging of the Penumbra in Ischemic Stroke: From the Concept to the Era of Mechanical Thrombectomy. Front Cardiovasc Med. 2022;9:861913.
4.
Rapillo CM, Dunet V, Pistocchi S, et al. Moving From CT to MRI Paradigm in Acute Ischemic Stroke: Feasibility, Effects on Stroke Diagnosis and Long-Term Outcomes. Stroke. 2024;55:1329–1338.
5.
Hui C, Tadi P, Khan Suheb MZ, et al. Ischemic Stroke. [Updated 2024 Apr 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.
6.
Ejma M, Madetko N, Brzecka A, et al. The Role of Stem Cells in the Therapy of Stroke. Curr Neuropharmacol. 2022;20:630–647.
7.
Liu K, Wang L, Pang T. Research progress of small-molecule natural medicines for the treatment of ischemic stroke. Chin J Nat Med. 2025;23:21–30.
8.
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke 2019; 50: e344–e418.
9.
Huo X, Sun D, Nguyen TN, et al. First-pass effect of mechanical thrombectomy for anterior circulation large vessel occlusion: incidence, predictors, and clinical impact. Insight from the ANGEL-ACT registry. J Neurosurg. 2023;139:670–677.
10.
Zaidat OO, Castonguay AC, Linfante I, et al. First Pass Effect: A New Measure for Stroke Thrombectomy Devices. Stroke. 2018;49:660–666. https://doi.org/10.1161/stroke....
11.
Di Maria F, Kyheng M, Consoli A, et al. On behalf of the ETIS investigators*. Identifying the predictors of first-pass effect and its influence on clinical outcome in the setting of endovascular thrombectomy for acute ischemic stroke: results from a multicentric prospective registry. Int J Stroke 2021;16: 20–28.
12.
Sarioglu O, Sarioglu FC, Capar AE, et al. Clot-based radiomics features predict first pass effect in acute ischemic stroke. Interv Neuroradiol. 2022;28:160–168.
13.
Shin JW, Jeong HS, Kwon HJ, et al. High red blood cell composition in clots is associated with successful recanalization during intra-arterial thrombectomy. PLoS One. 2018;13:e0197492.
14.
Jolugbo P, Ariëns RAS. Thrombus Composition and Efficacy of Thrombolysis and Thrombectomy in Acute Ischemic Stroke. Stroke. 2021;52:1131–1142.
15.
Nogueira RG, Pinheiro A, Brinjikji W, et al. Clot composition and recanalization outcomes in mechanical thrombectomy. J Neurointerv Surg. 2023:jnis-2023–020117.
16.
Turc G, Tsivgoulis G, Audebert HJ, et al. European Stroke Organisation—European Society for Minimally Invasive Neurological Therapy expedited recommendation on indication for intravenous thrombolysis before mechanical thrombectomy in patients with acute ischaemic stroke and anterior circulation large vessel occlusion. Eur Stroke J. 2022;7.
17.
Johnson JN, Srivatsan A, Chueh J, et al. Impact of histological clot composition on preprocedure imaging and mechanical thrombectomy. Brain Circ. 2022;8:87–93.
18.
Choi MH, Park GH, Lee JS, et al. Erythrocyte fraction within retrieved thrombi contributes to thrombolytic response in acute ischemic stroke. Stroke 2018;49:652-659.
19.
Karimian-Jazi K, Vollherbst DF, Schwarz D, et al. MR microscopy to assess clot composition following mechanical thrombectomy predicts recanalization and clinical outcome. J Neurointerv Surg. 2023:jnis-2023–020594.
20.
Niesten JM, van der Schaaf IC, van Dam L, et al. Histopathologic composition of cerebral thrombi of acute stroke patients is correlated with stroke subtype and thrombus attenuation. PLoS One. 2014;9(2):e88882.
21.
Liebeskind DS, Sanossian N, Yong WH, et al. CT and MRI early vessel signs reflect clot composition in acute stroke. Stroke. 2011;42:1237–1243.
22.
Horie N, Shobayashi K, Morofuji Y, et al. Impact of Mechanical Thrombectomy Device on Thrombus Histology in Acute Embolic Stroke. World Neurosurg. 2019;132:e418-e422.
| eISSN: | 1898-2263 |
| ISSN: | 1232-1966 |
Generation of the DOI (Digital Object Identifier) - task financed under the agreement No NrRCN/SP/0532/2021/1 by the Minister of Science and Higher
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