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- Title
Absence of susceptibility vessel sign is associated with aspiration-resistant fibrin/platelet-rich thrombi.
- Authors
Darcourt, Jean; Garcia, Cédric; Phuong, Do M.; Michelozzi, Caterina; Bellanger, Guillaume; Adam, Gilles; Roques, Margaux; Januel, Anne C.; Tall, Philippe; Albucher, Jean F.; Olivot, Jean M.; Bonneville, Fabrice; Payrastre, Bernard; Cognard, Christophe
- Abstract
Background: The composition of the thrombus influences its retrievability by mechanical thrombectomy. Purpose: Our study aimed to report on thrombi resistant to aspiration, regarding susceptibility vessel sign and histologic composition. Methods: This observational study was based on a prospective database of acute anterior circulation ischemic strokes treated by mechanical thrombectomy. Endovascular first-line strategy was aspiration and in case of failure, combined therapy-rescue was performed. The positivity of susceptibility vessel sign (SVSþ) or its negativity (SVS+) was assessed on T2* sequences. The thrombus composition was analyzed with hematoxylin eosin staining. Results: Histological analysis was performed on 102 clots. Thrombi with SVS+ were significantly richer in fibrin/platelets, p=0.04. Out of 210 mechanical thrombectomy, aspiration first pass strategy was performed in 131/210 (62%) patients. Combined therapy-rescue was needed in 37% of aspiration first pass strategy cases (n=131). Clots retrieved combined therapy-rescue were richer in fibrin/platelets 63.9% versus 50.8% for aspiration first pass strategy, p=0.03. Logistic regression analysis showed that fibrin/platelet-poor clots (<60%) were significantly more likely to be recanalized by aspiration first pass strategy compared to fibrin/platelet-rich clots (>60%) that were more likely recanalized by combined therapy-rescue after aspiration first pass strategy failure (OR=3.5; 95% CI=1.2-10.8; p=0.0054). Conclusions: Our results confirm that SVS-clots are rich in fibrin/platelets and suggest that these "white clots" are less likely to be retrieved by aspiration alone and more often require the use of combined therapy.
- Subjects
STROKE; ISCHEMIC stroke; LOGISTIC regression analysis; FIBRIN; THROMBECTOMY; THROMBOSIS
- Publication
International Journal of Stroke, 2021, Vol 16, Issue 8, p972
- ISSN
1747-4930
- Publication type
Article
- DOI
10.1177/1747493020986626