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Ischemic stroke
Original research
Intracranial thrombus composition is associated with occlusion location and endovascular treatment outcomes: results from ITACAT multicenter study
  1. Jesus Juega1,
  2. Manuel Requena1,2,
  3. Carlos Piñana2,
  4. Maite Rodriguez1,
  5. Jessica Camacho3,
  6. Marta Vidal3,
  7. Teresa Moliné3,
  8. Garazi Serna4,
  9. Carlos Palacio-Garcia5,
  10. Marta Rubiera1,
  11. Alvaro Garcia-Tornel1,
  12. Noelia Rodriguez-Villatoro1,
  13. David Rodriguez-Luna1,
  14. Marian Muchada1,
  15. Marta Olive Gadea1,
  16. Federica Rizzo1,
  17. Marc Rodrigo-Gisbert1,
  18. Carlos Lazaro1,
  19. David Hernandez2,
  20. Marta de Dios Lascuevas2,
  21. Francesco Diana2,
  22. Laura Dorado6,
  23. María Hernández-Pérez6,
  24. Helena Quesada7,
  25. Pere Cardona Portela7,
  26. Carolina De La Torre8,
  27. Santiago Ramon-y-Cajal3,
  28. Alejandro Tomasello2,
  29. Marc Ribo1,2,
  30. Carlos A Molina1,
  31. Jorge Pagola1
    1. 1Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital. Autonomous University of Barcelona. Vall d’Hebron Research Institute, Barcelona, Spain
    2. 2Interventional Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Barcelona, Spain
    3. 3Department of Pathology, Vall d'Hebron University Hospital, Barcelona, Spain
    4. 4Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
    5. 5Hematology Department, Vall d’Hebron University Hospital, Barcelona, Spain
    6. 6Stroke Unit. Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
    7. 7Stroke Unit, Department of Neurology, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
    8. 8Proteomics Unit, Josep Carreras Leukaemia Research Institute, Badalona, Spain
    1. Correspondence to Dr Jesus Juega, Stroke Unit, Department of Neurology, Vall d’Hebron Hospital, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain; jesusmjuega{at}gmail.com

    Abstract

    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.

    • Platelets
    • Stroke
    • Thrombectomy

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/jnis-2024-021654

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • X @marcriboj

      • Contributors JP is the guarantor. Conception and design: JJ, MR, and JP. Acquisition of the data: all authors. Analysis and interpretation of the data: JJ, JC, MR, and JP. Drafting the article: JJ, MR, and JP. Critically revising the article: all authors. Approved the final version of the manuscript: all authors.

      • Funding This work was supported by project 355/C/2017, Fundació La Marató de TV3 on strokes and traumatic spinal cord and brain injury, 2017 call of projects.

      • Competing interests MR reported receiving personal fees from Anaconda Biomed, AptaTargets, Cerenovus, Johnson & Johnson, Medtronic, Methinks, Philips, Sanofi, Stryker, and Rapid AI outside the submitted work.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.