Does prior administration of rtPA influence acute ischemic stroke clot composition? Findings from the analysis of clots retrieved with mechanical thrombectomy from the RESTORE registry

Autor: Alan O'Hare, Sara Molina, Jeanette Carlqvist, Klearchos Psychogios, Dennis Dunker, Ágnes Vadász, Georgios Magoufis, Annika Nordanstig, Seán Fitzgerald, Ray McCarthy, Karen M. Doyle, Michael Gilvarry, Rosanna Rossi, Ciara Tierney, Katarina Jood, Alexandros Rentzos, John Thornton, István Szikora, Erik Ceder, Andrew Douglas, Petra Redfors, Sarah Power, Turgut Tatlisumak, Paul Brennan, Abhay Pandit, András Nagy, Oana Madalina Mereuta, Georgios Tsivgoulis
Přispěvatelé: Science Foundation Ireland, European Regional Development Fund
Rok vydání: 2021
Předmět:
Zdroj: Journal of Neurology. 269:1913-1920
ISSN: 1432-1459
0340-5354
Popis: Background and purpose There is still much debate whether bridging-therapy [intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MT)] might be beneficial compared to MT alone. We investigated the effect of IVT on size and histological composition of the clots retrieved from patients undergoing bridging-therapy or MT alone. Methods We collected mechanically extracted thrombi from 1000 acute ischemic stroke (AIS) patients included in RESTORE registry. Patients were grouped according to the administration (or not) of IVT before thrombectomy. Gross photos of each clot were taken and Extracted Clot Area (ECA) was measured using ImageJ software. Martius Scarlett Blue stain was used to characterize the main histological clot components [red blood cells (RBCs), fibrin (FIB), platelets/other (PTL)] and Orbit Image Analysis was used for quantification. Additionally, we calculated the area of each main component by multiplying the component percent by ECA. Chi-squared and Kruskal–Wallis tests were used for statistical analysis. Results 451 patients (45%) were treated with bridging-therapy while 549 (55%) underwent MT alone. When considering only percent histological composition, we did not find any difference in RBC% (P = 0.895), FIB% (P = 0.458) and PTL% (P = 0.905). However, bridging-therapy clots were significantly smaller than MT-alone clots [32.7 (14.8–64.9) versus 36.8 (20.1–79.8) mm2, N = 1000, H1 = 7.679, P = 0.006*]. A further analysis expressing components per clot area showed that clots retrieved from bridging-therapy cases contained less RBCs [13.25 (4.29–32.06) versus 14.97 (4.93–39.80) mm2, H1 = 3.637, P = 0.056] and significantly less fibrin [9.10 (4.62–17.98) versus 10.54 (5.57–22.48) mm2, H1 = 7.920, P = 0.005*] and platelets/other [5.04 (2.26–11.32) versus 6.54 (2.94–13.79) mm2, H1 = 9.380, P = 0.002*] than MT-alone clots. Conclusions Our results suggest that previous IVT administration significantly reduces thrombus size, proportionally releasing all the main histological components.
Databáze: OpenAIRE
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