Intracranial thrombus composition is associated with occlusion location and endovascular treatment outcomes: results from ITACAT multicenter study

Jesus Juega, Manuel Requena, Carlos Piñana, Maite Rodriguez, Jessica Camacho, Marta Vidal, Teresa Moliné, Garazi Serna, Carlos Palacio-Garcia, Marta Rubiera, Alvaro Garcia-Tornel, Noelia Rodriguez-Villatoro, David Rodriguez-Luna, Marian Muchada, Marta Olive Gadea, Federica Rizzo, Marc Rodrigo-Gisbert, Carlos Lazaro, David Hernandez, Marta De Dios LascuevasFrancesco Diana, Laura Dorado, María Hernández-Pérez, Helena Quesada, Pere Cardona Portela, Carolina De La Torre, Santiago Ramon-Y-Cajal, Alejandro Tomasello, Marc Ribo, Carlos A. Molina, Jorge Pagola

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Background: The impact of thrombolytics directed towards different thrombus components regarding site of occlusion in combination with mechanical thrombectomy (MT) to achieve endovascular complete recanalization is unclear. Methods: Retrospective analysis of a prospective database in two stroke centers. Intracranial thrombi retrieved by MT were analyzed using hematoxylin-eosin staining for fibrin and red blood cell proportions, and CD61 immunostaining for platelets proportion in thrombus (PLTPT) assessment. Thrombi composition, baseline variables, etiology, treatment features and occlusion location were analyzed. Results: Overall, 221 patients completed the per protocol analysis and 110 cases achieved a final expanded Thrombolysis in Cerebral Infarction (eTICI) 3 (49%) of which 70 were MT (32%) by first pass effect (FPE). Thrombi from medium distal vessel occlusions had higher PLTPT compared with thrombi from proximal large vessel occlusions (68% vs 61%, P=0.026). In particular, middle cerebral artery M2-M3 segment thrombi had the highest PLTPT (70%), and basilar artery thrombi the lowest PLTPT (41%). After logistic regression analysis adjusted for occlusion location and intravenous fibrinolysis, lower baseline National Institutes of Health Stroke Scale score (adjusted OR (aOR) 0.95, 95% CI 0.913 to 0.998) and PLTPT (aOR 0.97, 95% CI 0.963 to 0.993) were independently associated with FPE. Fewer MT passes (aOR 0.67, 95% CI 0.538 to 0.842) and platelet poor thrombus (<62% PLTPT; aOR 2.39, 95% CI 1.288 to 4.440) were independently associated with final eTICI 3. Conclusions: Occlusion location might be a surrogate parameter for thrombus composition. Platelet poor clots and fewer MT passes were independently associated with complete endovascular recanalization. Clinical trials testing the benefits of combining selective intra-arterial platelet antagonists with MT to improve endovascular outcomes are warranted.

Idioma originalAnglès
Número d’articlejnis-2024-021654
RevistaJournal of NeuroInterventional Surgery
Estat de la publicacióAcceptada/en premsa - 2024
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