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Abstract
Purpose Mechanical thrombectomy has enabled the analysis of stroke clots. Pathological analysis of clot composition, focusing on the percentage of red blood cells (RBCs), has provided valuable findings that RBC-rich clots are associated with preoperative imaging and recanalization. However, little is known about the changes in clot characteristics rendered by the thrombectomy itself. We evaluated the impact of the thrombectomy devices employed on the composition of occlusive clots through an in vitro system.
Materials and Methods Two types of clot analogs (red blood cell [RBC]-rich and fibrin-rich) were used to simulate middle cerebral artery occlusions in a neurovascular model. Five retrieval methods were employed: 1) control (direct removal from the model), 2) aspiration, and a combined approach using aspiration and 3) EmboTrap, 4) Solitaire, or 5) Trevo. A total of 100 clots were obtained from 10 replicates and analyzed using Martius Scarlett Blue staining to determine the proportion of RBCs.
Results For RBC-rich clots, compared to the control group (control: 63%), RBC rates were similar in the aspiration group (aspiration: 63%). However, the three groups using stent retrievers (EmboTrap: 49%, Solitaire: 49%, Trevo: 50%) had lower RBC rates. On the other hand, in the fibrin-rich clot, there were no obvious differences between the five groups (control: 9%, aspiration: 10%, EmboTrap: 7%, Solitaire: 7%, Trevo: 8%).
Conclusion The pathological evaluation of the retrieved clot can be affected by the original clot type and the type of mechanical thrombectomy. These differences in changes in clot pathology need to be recognized for stroke research.
Disclosures T. Imahori: 1; C; Japan Society for the Promotion of Science Grants-in-Aid for Scientific Research. M. Ghovvati: None. L. Guo: None. A. M Gajjar: None. S. Tateshima: 2; C; Medtronic, Stryker, Cerenovus, Rapid Medical. N. Kaneko: 2; C; Medtronic, Stryker.