Patel, Biraj M
Mayo Clinic
Departments of Radiology and Neurosurgery, Carilion Clinic, Roanoke, VA, USA.
Citations 2
Histological evaluation of acute ischemic stroke thrombi may indicate the occurrence of vessel wall injury during mechanical thrombectomy
Mereuta, Oana Madalina , Abbasi, Mehdi , Fitzgerald, Seán , Dai, Daying , Kadirvel, Ram , Almekhlafi, Mohammed , Kvamme, Peter , Gounis, Matthew J. , Patel, Biraj M. , Aghaebrahim, Amin, Sauvageau, Eric , Bhuva, Parita, Soomro, Jazba , Thacker, Ike, Copelan, Alexander , Nazari, Pouya , Cantrell, Donald R. , Mohammaden, Mahmoud , Pisani, Leonardo , Puri, Ajit S , Meves, Alexander , Larco, Jorge Arturo , Cloft, Harry J. , Kallmes, David F. , Doyle, Karen , Brinjikji, Waleed , Almekhlafi, Mohammed A , Mendes Pereira, Vitor , Jahromi, Babak S , Gounis, Matthew J , Nazari, Pouya , Al-Bayati, Alhamza , Pisani, Leonardo , Rodrigues, Gabriel Martins , Arturo Larco, Jorge L , Savastano, Luis , Doyle, Karen M , Brinjikji, Waleed , Patel, Biraj M , Fitzgerald, Seán , Dai, Daying , Madalina Mereuta, Oana , Kadirvel, Ramanathan , Hanel, Ricardó A. , Yoo, Albert J. , Layton, Kennith F. , Almandoz, Josser E Delgado , Jahromi, Babak S. , Nogueira, Raul G. , Demchuk, Andrew M. , Kayan, Yasha , Haussen, Diogo C , Al‐Bayati, Alhamza R , Entwistle, John
Journal of NeuroInterventional Surgery | May 11, 2021 | Volume: 14 | Issue: 4 | Pages: 356-361
10.1136/neurintsurg-2021-017310
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.
Per pass analysis of thrombus composition retrieved by mechanical thrombectomy
Abbasi, Mehdi , Kvamme, Peter , Patel, Biraj M. , Gounis, Matthew J. , Kadirvel, Ramanathan , Kallmes, David F. , Doyle, Karen , Cloft, Harry J. , Liu, Yang , Thacker, Ike, Aghaebrahim, Amin, Sauvageau, Eric , Copelan, Alexander , Nazari, Pouya , Cantrell, Donald R. , Bhuva, Parita, Soomro, Jazba , Mohammaden, Mahmoud , Pisani, Leonardo , Puri, Ajit S , Brinjikji, Waleed , Patel, Biraj M , Fitzgerald, Seán , Mereuta, Oana M, Dai, Daying , Kadirvel, Ram , Kallmes, David F , Savastano, Luis E., Kayan, Yasha , Nazari, Pouya , Al-Bayati, Alhamza , Brinjikji, Waleed , Liu, Yang , Layton, Kennith F. , Hanel, Ricardó A. , Almekhlafi, Mohammed , Almandoz, Josser E Delgado , Mendes Pereira, Vitor , Jahromi, Babak S. , Yoo, Albert J. , Nogueira, Raul G. , Fitzgerald, Seán , Mereuta, Oana Madalina , Dai, Daying , Savastano, Luis , Demchuk, Andrew M. , Entwistle, John, Haussen, Diogo C , Al‐Bayati, Alhamza R , Rodrigues, Gabriel Martins
Interventional Neuroradiology | April 7, 2021 | Volume: 27 | Issue: 6 | Pages: 815-820
Background and aim Mechanical thrombectomy (MT) for large vessel occlusion often requires multiple passes to retrieve the entire thrombus load. In this multi-institutional study we sought to examine the composition of thrombus fragments retrieved with each pass during MT. Methods Patients who required multiple passes during thrombectomy were included. Histopathological evaluation of thrombus fragments retrieved from each pass was performed using Martius Scarlet Blue staining and the composition of each thrombus component including RBC, fibrin and platelet was determined using image analysis software. Results 154 patients underwent MT and 868 passes was performed which resulted in 263 thrombus fragments retrieval. The analysis of thrombus components per pass showed higher RBC, lower fibrin and platelet composition in the pass 1 and 2 when compared to pass 3 and passes 4 or more combined (P values <0.05). There were no significant differences between thrombus fragments retrieved in pass 1 and pass 2 in terms of RBC, WBC, fibrin, and platelet composition (P values >0.05). Similarly, when each composition of thrombus fragments retrieved in pass 3 and passes 4 or more combined were compared with each other, no significant difference was noted (P values >0.05). Conclusion Our findings confirm that thrombus fragments retrieved with each pass differed significantly in histological content. Fragments in the first passes were associated with lower fibrin and platelet composition compared to fragments retrieved in passes three and four or higher. Also, thrombus fragments retrieved after failed pass were associated with higher fibrin and platelet components.