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Abstract
Background An increasing number of acute ischaemic stroke patients are being treated with embolectomy devices. A pathological analysis of these extracted “clots” may be important in understanding device behaviour and procedure success.
Methodology Extracted clots from AIS patients undergoing endovascular procedures were prospectively analysed. The pathological assessment included an analysis of the fibrin content and the RBC and WBC ratios. A higher fibrin content indicating a relatively organised thrombus and a higher RBC content suggesting more acute thrombus. A correlative imaging analysis was performed by measurement of the hounsefield units (HU) of the clot on the pre-intervention NCCT as well as the HU of an uninvolved vessel in the contralateral hemisphere. The demographic data and co-morbidities were recorded for each extracted thrombus.
Results A total of 16 clots were analysed. The clot location, the fibrin, RBC and WBC content as well as the HU for the clot and the normal blood vessel are listed in table 1. The mean HU for the clots was 56 ± 9.7 while the HU over the normal blood vessel was 33 ± 8. A higher HU had was associated with a lower fibrin content, higher RBC content and lower WBC content. There was no significant association with age or any of the co-morbidities. However there was a trend for higher fibrin content (older clot) and lower RBC% in patients with diabetes, hypertension and hyperlipidaemia. A multi-layered clot indicated a more organised and hence older thrombus, this was also seen in a higher percentage of diabetic patients, however this was not significant. Patients with atrial fibrillation had lower mean HU corresponding to a higher fibrin content (older clot).
Conclusions A preliminary analysis of prospectively collected embolectomy specimens indicated a variation in the content of fibrin and RBC composition. The sample size was not large enough to determine statistical associations however there were trends indicating older clots in patients with diabetes, hyperlipidaemia and atrial fibrillation. These preliminary trends may be significant in a larger sample and we continue to collect this data.
Disclosures B. Cline: None. J. Vos: None. J. Carpenter: None. A. Rai: 2; C; Stryker Neurovascular, Codman Neurovascular.