Abstract TP7: Association of Retrieved Thrombus Composition With Measures of Thrombectomy Success

Introduction: Emboli retrieved from stroke patients undergoing mechanical thrombectomy vastly differ in histopathologic appearance, likely reflecting varying etiologies of stroke. We investigated whether clot components correlated with clinical features and thrombectomy outcomes. Methods: Retrieved thrombi from endovascular thrombectomy in consecutive AIS-LVO patients at 2 academic medical centers were fixed in formalin and sections stained by hematoxylin and eosin. The RBC, WBC and fibrin percentages of the clot were quantified by a neuropathologist blinded to the clinical details. We evaluated the association of these clot components, patient demographic and clinical features, with TICI score (both ordinal and dichotomized at 2c), AOL score, number of thrombectomy passes, and first-pass substantial recanalization (≥TICI 2b result on the first thrombectomy device pass). Non-parametric values were computed via Spearman correlation and pairwise interaction of clinical features was analyzed by ordinal logistic regression. Results: Among the 75 analyzed patients, mean age was 71.4 (SD 17.7), 50.7% were female and presenting NIHSS mean was 16.1 (SD 7.6). Devices employed were stent retrievers in 71% of patients, aspiration in 10%, and both stent retrievers and aspiration in 19%. Number of passes per procedure was mean 2.16 (SD 1.21). Substantial reperfusion (TICI 2B-3) was achieved in 88% and excellent reperfusion (TICI 2C-3) in 44%. In retrieved thrombi, mean RBC% was 44.8% (SD 31.9) and mean fibrin% was 49.8% (SD 31.4). Rates of first-pass substantial reperfusion, final substantial reperfusion, and final excellent reperfusion were homogenous across wide ranges of retrieved thrombus RBC% and fibrin% in correlation analysis. Conclusion: RBC and fibrin composition range widely among retrieved thrombi causing acute ischemic stroke. Current generation thrombectomy devices perform well across a broad range of clot compositions.

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Abstract WP66: Impaired Collaterals Are Associated With Intracranial Thrombus Extension: Evidence From MRI, Catheter Angiography, and Retrieved Thrombus Composition

Stroke ◽

10.1161/str.51.suppl_1.wp66 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Neal M Rao ◽

Kunakorn Atchaneeyasakul ◽

Jiang Hongquan ◽

Laura Solano ◽

William H Yong ◽

...

Keyword(s):

Ischemic Stroke ◽

Academic Medical Centers ◽

Spearman Correlation ◽

Catheter Angiography ◽

Endovascular Thrombectomy ◽

Medical Centers ◽

Academic Medical ◽

Percent Composition ◽

Hematoxylin And Eosin ◽

Number Of Passes

Background: Clot propagation after initial occlusion may increase target thrombus burden and its pathophysiologic basis has not been extensively studied in acute human ischemic stroke. We investigated whether clot characteristics on MRI, catheter angiography, and thrombus histopathology indicated that impaired collaterals may be associated with extension of acute intracranial occlusions via stasis clotting in slow flow arterial segments. Methods: Analysis of consecutive AIS-LVO endovascular thrombectomy patients at 2 academic medical centers with: 1) pretreatment MRI, and 2) retrieved thrombi. GRE MR susceptibility vessel sign presence and extent of ASITN collateral scores were rated by blinded assessors. Extracted clots were fixed in formalin, stained by hematoxylin and eosin, and RBC, WBC and fibrin percent composition quantified by a neuropathologist blinded to clinical details. We evaluated the correlation of collateral grade with clot size by susceptibility vessel sign (SVS) and clot composition by RBC%. Non-parametric values were computed via Spearman correlation. Results: Among the 48 patients, mean age was 71.4 (SD 17.7), 56.3% female, and mean presenting NIHSS was 15.5 (SD 7.41). A susceptibility vessel sign was present in 65%, with mean SVS length 15.6 mm (SD 8.3). Collateral scores were mean 2.3 (SD 1.2). The number of passes per procedure was mean 1.98 (SD 1.30) The presence of a susceptibility vessel sign correlated with higher RBC% in retrieved thrombi (r s =0.36 p=0.011). Worse collateral grades correlated with longer SVS length (r s =-0.50 p=0.004) and greater SVS width (r s =-0.54 p=0.002). Worse collateral grade also trended toward correlation with higher RBC% in retrieved clots (r s =-0.19 p=0.18). Conclusion: Impaired angiographic collaterals are associated with longer RBC-rich thrombi on susceptibility imaging and trend toward association with higher RBC% in retrieved thrombi. These findings support that, in LVO acute ischemic stroke, clot propagation after initial occlusion occurs by stasis clotting accelerated by impaired collaterals.

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Health Industry Practices That Create Conflicts of Interest: A Policy Proposal for Academic Medical Centers

Yearbook of Dermatology and Dermatologic Surgery ◽

10.1016/s0093-3619(08)70170-9 ◽

2006 ◽

Vol 2006 ◽

pp. 221-222

Author(s):

B.H. Thiers

Keyword(s):

Conflicts Of Interest ◽

Academic Medical Centers ◽

Policy Proposal ◽

Medical Centers ◽

Academic Medical

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Discharge Practices for COVID-19 Patients: Rapid Review of Published Guidance and Synthesis of Documents and Practices at 22 US Academic Medical Centers

Journal of General Internal Medicine ◽

10.1007/s11606-021-06711-x ◽

2021 ◽

Author(s):

S. Ryan Greysen ◽

◽

Andrew D. Auerbach ◽

Matthew D. Mitchell ◽

Jennifer N Goldstein ◽

...

Keyword(s):

Academic Medical Centers ◽

Rapid Review ◽

Medical Centers ◽

Academic Medical

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Unplanned Reoperation and Implant Revision After Total Wrist Arthroplasty

Hand ◽

10.1177/1558944719898817 ◽

2020 ◽

pp. 155894471989881 ◽

Cited By ~ 1

Author(s):

Taylor M. Pong ◽

Wouter F. van Leeuwen ◽

Kamil Oflazoglu ◽

Philip E. Blazar ◽

Neal Chen

Keyword(s):

Risk Factors ◽

Implant Removal ◽

Academic Medical Centers ◽

Implant Design ◽

Factors Associated ◽

Medical Centers ◽

Total Wrist Arthroplasty ◽

Academic Medical ◽

Related Risk ◽

Wrist Arthroplasty

Background: Total wrist arthroplasty (TWA) is a treatment option for many debilitating wrist conditions. With recent improvements in implant design, indications for TWA have broadened. However, despite these improvements, there are still complications associated with TWA, such as unplanned reoperation and eventual implant removal. The goal of this study was to identify risk factors for an unplanned reoperation or implant revision after a TWA at 2 academic medical centers between 2002 and 2015. Methods: In this retrospective study, 24 consecutive TWAs were identified using CPT codes. Medical records were manually reviewed to identify demographic, patient- or disease-related, and surgery-related risk factors for reoperation and implant removal after a primary TWA. Results: Forty-six percent of wrists (11 of 24 TWAs performed) had a reoperation after a median of 3.4 years, while 29% (7 of 24) underwent implant revision after a median of 5 years. Two patients had wrist surgery prior to their TWA, both eventually had their implant removed ( P = .08). There were no risk factors associated with reoperation or implant removal. Conclusion: Unplanned reoperation and implant removal after a primary TWA are common. Approximately 1 in 3 wrists are likely to undergo revision surgery. We found no factors associated with reoperation or implant removal; however, prior wrist surgery showed a trend toward risk of implant removal after TWA.

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