Science and Research

Interventional stroke treatment - Is it also safe for arteries? Looking at thrombectomy wall damage through clot histology

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.
  • Donnerstag, F.
  • Götz, F.
  • Dadak, M.
  • Raab, P.
  • Iglesias, E. C.
  • Werlein, C.
  • Lanfermann, H.
  • Jonigk, D.

Keywords

  • Stroke
  • intracranial thrombosis
  • pathology
  • thrombectomy
Publication details
DOI: 10.1177/1591019920976673
Journal: Interv Neuroradiol
Pages: 1591019920976673 
Work Type: Original
Location: BREATH
Disease Area: General Lung and Other
Partner / Member: MHH
Access-Number: 33269973

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