High-Resolution Imaging of Interaction Between Thrombus and Stent-Retriever in Patients With Acute Ischemic Stroke.
BACKGROUND
Currently, acute ischemic stroke is still a leading cause of mortality and morbidity. Approximately 2 years ago, mechanical thrombectomy was proven beneficial as a revolutionary new therapy for stroke in the MR-CLEAN trial (A Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). However, the mechanisms by which the thrombectomy device, or stent-retriever, interacts with the thrombus are largely unknown. A better understanding could lead to improved efficacy of mechanical thrombectomy devices.


METHODS AND RESULTS
Seven stent-retrievers with thrombi still entrapped were collected directly after thrombectomy. The stent-retrievers were studied using micro computed tomography, followed by scanning electron microscopy and light microscopy. Two independent observers rated interaction type and thrombus surface structure (porous filamentous or dense) at the interaction sites.A total of 79 interaction sites between thrombus and stent-retriever were categorized. Thrombus-stent-retriever interaction was found to be adhesive (n=44; 56%) or mechanical (n=35; 44%). Adhesive interaction was most frequently observed at interaction sites with a dense surface, compared with interaction sites with a porous filamentous fibrin surface (38/58; 66% versus 6/21; 29%, P=0.011).


CONCLUSIONS
The interaction between thrombus and stent-retriever was predominantly adhesive, not mechanical. Adhesive interaction was strongly associated with the presence of a dense thrombus surface without a porous filamentous fibrin network.
['Autar|Anouchska S A|ASA|', 'Hund|Hajo M|HM|', 'Ramlal|Sharad A|SA|', 'Hansen|Daniël|D|', 'Lycklama À Nijeholt|Geert J|GJ|', 'Emmer|Bart J|BJ|', 'de Maat|Moniek P M|MPM|', 'Dippel|Diederik W J|DWJ|', 'van der Lugt|Aad|A|', 'van Es|Adriaan C G M|ACGM|', 'van Beusekom|Heleen M M|HMM|', '|||']
D000268:Adhesiveness D002545:Brain Ischemia D006801:Humans D020767:Intracranial Thrombosis D008855:Microscopy, Electron, Scanning D009426:Netherlands D016062:Porosity D011446:Prospective Studies D011474:Prosthesis Design D012042:Registries D015607:Stents D020521:Stroke D013499:Surface Properties D017131:Thrombectomy D015912:Thrombolytic Therapy D055114:X-Ray Microtomography
thrombus ischemic stroke mechanical thrombectomy scanning electron microscopy stent‐retriever