PT  - JOURNAL ARTICLE
AU  - Yang Liu
AU  - Waleed Brinjikji
AU  - Mehdi Abbasi
AU  - Daying Dai
AU  - Jorge L Arturo Larco
AU  - Sarosh Irfan Madhani
AU  - Adnan H Shahid
AU  - Oana Madalina Mereuta
AU  - Raul G Nogueira
AU  - Peter Kvamme
AU  - Kennith F Layton
AU  - Josser E Delgado Almandoz
AU  - Ricardo A Hanel
AU  - Vitor Mendes Pereira
AU  - Mohammed A Almekhlafi
AU  - Albert J Yoo
AU  - Babak S Jahromi
AU  - Matthew J Gounis
AU  - Biraj Patel
AU  - Seán Fitzgerald
AU  - Karen Doyle
AU  - Diogo C Haussen
AU  - Alhamza R Al-Bayati
AU  - Mahmoud Mohammaden
AU  - Leonardo Pisani
AU  - Gabriel Martins Rodrigues
AU  - Ike C Thacker
AU  - Yasha Kayan
AU  - Alexander Copelan
AU  - Amin Aghaebrahim
AU  - Eric Sauvageau
AU  - Andrew M Demchuk
AU  - Parita Bhuva
AU  - Jazba Soomro
AU  - Pouya Nazari
AU  - Donald Robert Cantrell
AU  - Ajit S Puri
AU  - John Entwistle
AU  - Ramanathan Kadirvel
AU  - Harry J Cloft
AU  - David F Kallmes
AU  - Luis Savastano
TI  - Quantification of clot spatial heterogeneity and its impact on thrombectomy
AID  - 10.1136/neurintsurg-2021-018183
DP  - 2022 Dec 01
TA  - Journal of NeuroInterventional Surgery
PG  - 1248--1252
VI  - 14
IP  - 12
4099  - http://jnis.bmj.com/content/14/12/1248.short
4100  - http://jnis.bmj.com/content/14/12/1248.full
SO  - J NeuroIntervent Surg2022 Dec 01; 14
AB  - Background Compositional and structural features of retrieved clots by thrombectomy can provide insight into improving the endovascular treatment of ischemic stroke. Currently, histological analysis is limited to quantification of compositions and qualitative description of the clot structure. We hypothesized that heterogeneous clots would be prone to poorer recanalization rates and performed a quantitative analysis to test this hypothesis.Methods We collected and did histology on clots retrieved by mechanical thrombectomy from 157 stroke cases (107 achieved first-pass effect (FPE) and 50 did not). Using an in-house algorithm, the scanned images were divided into grids (with sizes of 0.2, 0.3, 0.4, 0.5, and 0.6 mm) and the extent of non-uniformity of RBC distribution was computed using the proposed spatial heterogeneity index (SHI). Finally, we validated the clinical significance of clot heterogeneity using the Mann–Whitney test and an artificial neural network (ANN) model.Results For cases with FPE, SHI values were smaller (0.033 vs 0.039 for grid size of 0.4 mm, P=0.028) compared with those without. In comparison, the clot composition was not statistically different between those two groups. From the ANN model, clot heterogeneity was the most important factor, followed by fibrin content, thrombectomy techniques, red blood cell content, clot area, platelet content, etiology, and admission of intravenous tissue plasminogen activator (IV-tPA). No statistical difference of clot heterogeneity was found for different etiologies, thrombectomy techniques, and IV-tPA administration.Conclusions Clot heterogeneity can affect the clot response to thrombectomy devices and is associated with lower FPE. SHI can be a useful metric to quantify clot heterogeneity.All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.