Fibrin-Platelet Clots in Acute Ischemic Stroke. Predictors and Clinical Significance in a Mechanical Thrombectomy Series
Introduction: The histological composition of the clot influences its mechanical properties, affects the efficacy of endovascular treatment (EVT), and could determine the clinical outcome of patients with acute ischemic stroke (AIS). Insights into clot composition may guide therapeutic decision-maki...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-04-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2021.631343/full |
| _version_ | 1819285159916077056 |
|---|---|
| author | Francisco Hernández-Fernández María E. Ramos-Araque María E. Ramos-Araque Rosa Barbella-Aponte Juan David Molina-Nuevo Jorge García-García Oscar Ayo-Martin María José Pedrosa-Jiménez Lorena López-Martinez Gemma Serrano-Heras Enrique Julia-Molla Tomás Segura Tomás Segura |
| author_facet | Francisco Hernández-Fernández María E. Ramos-Araque María E. Ramos-Araque Rosa Barbella-Aponte Juan David Molina-Nuevo Jorge García-García Oscar Ayo-Martin María José Pedrosa-Jiménez Lorena López-Martinez Gemma Serrano-Heras Enrique Julia-Molla Tomás Segura Tomás Segura |
| author_sort | Francisco Hernández-Fernández |
| collection | DOAJ |
| description | Introduction: The histological composition of the clot influences its mechanical properties, affects the efficacy of endovascular treatment (EVT), and could determine the clinical outcome of patients with acute ischemic stroke (AIS). Insights into clot composition may guide therapeutic decision-making prior to EVT and facilitate revascularization therapies.Material and Methods: Consecutive patients with AIS recorded in a prospective single-center reperfusion registry from December 2015 to December 2019 and treated with EVT were included. Baseline, laboratory [including post-procedural C-reactive protein (CRP)], radiological, and angiographic variables were analyzed. We aimed to study the relationship between histological composition of the clot with basal neuroimaging, laboratory markers, and recanalization technique. The secondary outcome was to analyze the correlation between clot composition and functional outcome at 3 months assessed by the modified Rankin scale (mRS).Results: From the study period, 360 AIS patients treated with EVT were included, of whom 189 (53%) fulfilled the inclusion criteria. One hundred (53%) cases of fibrin-predominant clot (FPC) were recorded. Full recanalization in FPC cases was achieved with higher probability when stent retrievers (SR) were selected as the first-line device (68.2%, p = 0.039). Patients with FPC had higher levels of CRP (p = 0.02), lower frequency of the hyperdense middle cerebral artery (HMCA) in baseline imaging (p = 0.039), and higher rates of mortality (p = 0.012). The multivariate analysis showed that the absence of HMCA (OR = 0.420; 95% CI 0.197–0.898; p = 0.025) and higher levels of CRP (OR = 1.01; 95% CI 1.003–1.019; p = 0.008) were predictors of FPC. Leukocytes and platelet counts were not associated with clot histology.Conclusions: The absence of HMCA and higher levels of CRP were markers of FPC. In patients with FPC, complete recanalization was most likely to be achieved when a SR was selected as first line of treatment. Mortality was higher in patients within this histologic group. |
| first_indexed | 2024-12-24T01:58:51Z |
| format | Article |
| id | doaj.art-17cba167a8d344a985fba7459aa01c69 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-24T01:58:51Z |
| publishDate | 2021-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-17cba167a8d344a985fba7459aa01c692022-12-21T17:21:29ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-04-011210.3389/fneur.2021.631343631343Fibrin-Platelet Clots in Acute Ischemic Stroke. Predictors and Clinical Significance in a Mechanical Thrombectomy SeriesFrancisco Hernández-Fernández0María E. Ramos-Araque1María E. Ramos-Araque2Rosa Barbella-Aponte3Juan David Molina-Nuevo4Jorge García-García5Oscar Ayo-Martin6María José Pedrosa-Jiménez7Lorena López-Martinez8Gemma Serrano-Heras9Enrique Julia-Molla10Tomás Segura11Tomás Segura12Department of Neurology, Hospital General Universitario de Albacete, Albacete, SpainDepartment of Neurology, University Hospital of Salamanca, Biomedical Research Institute of Salamanca, Salamanca, SpainDepartment of Neurology, University Hospital of Valladolid, Valladolid, SpainDepartment of Surgical Pathology, Hospital General Universitario de Albacete, Albacete, SpainDepartment of Radiology, Hospital General Universitario de Albacete, Albacete, SpainDepartment of Neurology, Hospital General Universitario de Albacete, Albacete, SpainDepartment of Neurology, Hospital General Universitario de Albacete, Albacete, SpainDepartment of Radiology, Hospital General Universitario de Albacete, Albacete, SpainDepartment of Radiology, Hospital General Universitario de Albacete, Albacete, SpainResearch Unit, Hospital General Universitario de Albacete, Albacete, SpainDepartment of Radiology, Hospital General Universitario de Albacete, Albacete, SpainDepartment of Neurology, Hospital General Universitario de Albacete, Albacete, SpainInstituto de Investigación en Discapacidades Neurológicas (IDINE), Facultad de Medicina, Universidad de Castilla-La Mancha, Albacete, SpainIntroduction: The histological composition of the clot influences its mechanical properties, affects the efficacy of endovascular treatment (EVT), and could determine the clinical outcome of patients with acute ischemic stroke (AIS). Insights into clot composition may guide therapeutic decision-making prior to EVT and facilitate revascularization therapies.Material and Methods: Consecutive patients with AIS recorded in a prospective single-center reperfusion registry from December 2015 to December 2019 and treated with EVT were included. Baseline, laboratory [including post-procedural C-reactive protein (CRP)], radiological, and angiographic variables were analyzed. We aimed to study the relationship between histological composition of the clot with basal neuroimaging, laboratory markers, and recanalization technique. The secondary outcome was to analyze the correlation between clot composition and functional outcome at 3 months assessed by the modified Rankin scale (mRS).Results: From the study period, 360 AIS patients treated with EVT were included, of whom 189 (53%) fulfilled the inclusion criteria. One hundred (53%) cases of fibrin-predominant clot (FPC) were recorded. Full recanalization in FPC cases was achieved with higher probability when stent retrievers (SR) were selected as the first-line device (68.2%, p = 0.039). Patients with FPC had higher levels of CRP (p = 0.02), lower frequency of the hyperdense middle cerebral artery (HMCA) in baseline imaging (p = 0.039), and higher rates of mortality (p = 0.012). The multivariate analysis showed that the absence of HMCA (OR = 0.420; 95% CI 0.197–0.898; p = 0.025) and higher levels of CRP (OR = 1.01; 95% CI 1.003–1.019; p = 0.008) were predictors of FPC. Leukocytes and platelet counts were not associated with clot histology.Conclusions: The absence of HMCA and higher levels of CRP were markers of FPC. In patients with FPC, complete recanalization was most likely to be achieved when a SR was selected as first line of treatment. Mortality was higher in patients within this histologic group.https://www.frontiersin.org/articles/10.3389/fneur.2021.631343/fullstrokethrombectomyfibrinthrombolysis (tPA)mortality |
| spellingShingle | Francisco Hernández-Fernández María E. Ramos-Araque María E. Ramos-Araque Rosa Barbella-Aponte Juan David Molina-Nuevo Jorge García-García Oscar Ayo-Martin María José Pedrosa-Jiménez Lorena López-Martinez Gemma Serrano-Heras Enrique Julia-Molla Tomás Segura Tomás Segura Fibrin-Platelet Clots in Acute Ischemic Stroke. Predictors and Clinical Significance in a Mechanical Thrombectomy Series Frontiers in Neurology stroke thrombectomy fibrin thrombolysis (tPA) mortality |
| title | Fibrin-Platelet Clots in Acute Ischemic Stroke. Predictors and Clinical Significance in a Mechanical Thrombectomy Series |
| title_full | Fibrin-Platelet Clots in Acute Ischemic Stroke. Predictors and Clinical Significance in a Mechanical Thrombectomy Series |
| title_fullStr | Fibrin-Platelet Clots in Acute Ischemic Stroke. Predictors and Clinical Significance in a Mechanical Thrombectomy Series |
| title_full_unstemmed | Fibrin-Platelet Clots in Acute Ischemic Stroke. Predictors and Clinical Significance in a Mechanical Thrombectomy Series |
| title_short | Fibrin-Platelet Clots in Acute Ischemic Stroke. Predictors and Clinical Significance in a Mechanical Thrombectomy Series |
| title_sort | fibrin platelet clots in acute ischemic stroke predictors and clinical significance in a mechanical thrombectomy series |
| topic | stroke thrombectomy fibrin thrombolysis (tPA) mortality |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2021.631343/full |
| work_keys_str_mv | AT franciscohernandezfernandez fibrinplateletclotsinacuteischemicstrokepredictorsandclinicalsignificanceinamechanicalthrombectomyseries AT mariaeramosaraque fibrinplateletclotsinacuteischemicstrokepredictorsandclinicalsignificanceinamechanicalthrombectomyseries AT mariaeramosaraque fibrinplateletclotsinacuteischemicstrokepredictorsandclinicalsignificanceinamechanicalthrombectomyseries AT rosabarbellaaponte fibrinplateletclotsinacuteischemicstrokepredictorsandclinicalsignificanceinamechanicalthrombectomyseries AT juandavidmolinanuevo fibrinplateletclotsinacuteischemicstrokepredictorsandclinicalsignificanceinamechanicalthrombectomyseries AT jorgegarciagarcia fibrinplateletclotsinacuteischemicstrokepredictorsandclinicalsignificanceinamechanicalthrombectomyseries AT oscarayomartin fibrinplateletclotsinacuteischemicstrokepredictorsandclinicalsignificanceinamechanicalthrombectomyseries AT mariajosepedrosajimenez fibrinplateletclotsinacuteischemicstrokepredictorsandclinicalsignificanceinamechanicalthrombectomyseries AT lorenalopezmartinez fibrinplateletclotsinacuteischemicstrokepredictorsandclinicalsignificanceinamechanicalthrombectomyseries AT gemmaserranoheras fibrinplateletclotsinacuteischemicstrokepredictorsandclinicalsignificanceinamechanicalthrombectomyseries AT enriquejuliamolla fibrinplateletclotsinacuteischemicstrokepredictorsandclinicalsignificanceinamechanicalthrombectomyseries AT tomassegura fibrinplateletclotsinacuteischemicstrokepredictorsandclinicalsignificanceinamechanicalthrombectomyseries AT tomassegura fibrinplateletclotsinacuteischemicstrokepredictorsandclinicalsignificanceinamechanicalthrombectomyseries |