Abstract 1122‐000211: Histology Profiles of Thrombi in Men and Women Undergoing Thrombectomy

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Justin F Fraser ◽  
Christopher P Kellner ◽  
James Vicari ◽  
Dennis Rivet ◽  
B. Keith Woodward ◽  
...  
Keyword(s):  
Large Vessel ◽  
Tissue Composition ◽  
Vessel Occlusion ◽  
Men And Women ◽  
Patient Demographics ◽  
Procedural Information ◽  
Arterial Blood ◽  
Pixel Analysis ◽  
Enrollment Data ◽  
Insight Into

Introduction : Understanding clot composition and associated genomic, epigenomic, and proteomic signatures could provide insight into thrombus biology and etiology, and aid in prognosis in stroke. We report preliminary analysis of histology evaluations in subjects enrolled in the INSIGHT Registry, a multicentered ‘multi‐omic’ analysis of thrombi associated with acute hemorrhagic and ischemic stroke this multi‐omic clot collection registry. Our aim was to determine potential histology differences between men and women with emergent large vessel occlusive thrombi. Methods : Subjects age ≥18 years, treated frontline with the Penumbra System® for thrombectomy are included in this analysis. Patient demographics, medical history, radiographic, and procedural information are collected in conjunction with extracted clot and concurrent extracranial arterial blood. Enrollment, data collection and monitoring are ongoing for the INSIGHT registry. While the protocol include analysis for proteomics and transcriptomics, for this analysis we used automated histology. An MSB Trichrome stain was used to evaluate the tissue. Composition was determined by automated pixel analysis, with the values representing ratios of the overall clot. Results : Samples from 60 subjects were enrolled from 10 sites between 02/2021 and 07/2021. Analysis of the thrombi determined the relative proportions of fibrin, red blood cells (RBCs), and platelets (PLT). The median RBC‐fibrin ratio did not differ between females (1.27, IQR 0.57‐2.62) n = 34 and males (0.95, IQR 0.41‐1.51) n = 26. However, the ratio was more widely distributed in females as seen in the wider IQR. Conclusions : These preliminary results demonstrate a lack of uniform differences in thrombus composition in males versus females with emergent large vessel occlusion. There may be more heterogeneity among females, which requires further study.

scholarly journals Mechanical Thrombectomy of Large Vessel Occlusions in COVID-19 Related Stroke: Endovascular and Clinical Outcomes

2020 ◽  
Author(s):  
Anas S. Al-Smadi ◽  
Srishti Abrol ◽  
Ali Luqman ◽  
Parthasarathi Chamiraju ◽  
Hani Abujudeh
Keyword(s):  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Case Series ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Ischemic Disease ◽  
Patient Demographics

Abstract Background and PurposeStroke is a drastic complication and a poor prognostic marker of COVID-19 disease which emphasizes the importance of early identification and management of this complication. In this case series, we describe our experience of mechanical thrombectomy of large vessel occlusions (LVO) in patients with COVID-19.MethodsWe performed a retrospective study of a series of confirmed COVID-19 patients who underwent endovascular thrombectomy for acute cerebrovascular ischemic disease with large vessel occlusion. Patient demographics, presentations, lab values, angiographic and clinical outcomes were also reviewed.ResultsThree COVID-19 patients with large vessel occlusion who underwent endovascular thrombectomy were identified in our multi-center institution. Two patients had respiratory symptoms prior presentation and one patient presented initially with clinical deficits. Two patients had anterior circulation occlusion in the middle cerebral artery territory vs one had posterior circulation occlusion in the basilar artery. There was good angiographic outcome post thrombectomy in all patients, however poor clinical outcomes noted with no significant improvement in neurological manifestations in comparison with baseline at presentation. All patients developed critically severe symptoms during hospitalization requiring intubation and one patient died of COVID-19 related respiratory failure.ConclusionIn this small case series, we noted worse clinical outcomes in COVID-19 related LVO stroke despite effective thrombectomy, which may be related to the underlying COVID-19 disease and/or the nature of clot in these patients.

Abstract 1122‐000220: Analysis of Protein Network to Predict Cognition Among Emergent Large Vessel Occlusion Undergoing Mechanical Thrombectomy

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Chintan Rupareliya ◽  
Jacqueline A Frank ◽  
Benton Maglinger ◽  
Madison Sands ◽  
Christopher J McLouth ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Large Vessel ◽  
Minor Stroke ◽  
Biological Processes ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Severe Stroke ◽  
Arterial Blood

Introduction : Emergent Large Vessel Occlusion (ELVO) strokes are devastating ischemic vascular events that can cause severe and permanent impairment. The purpose of the current study is to investigate interactions among different proteins at the time of mechanical thrombectomy (MT) which correlates to Montreal Cognitive Assessment (MOCA) scores at discharge and at 90‐day follow‐up. Methods : The Blood And Clot Thrombectomy Registry And Collaboration (BACTRAC) study is a continually enrolling tissue bank (clinicaltrials.gov NCT03153683) and registry from stroke patients undergoing mechanical thrombectomy. Blood samples from systemic arterial blood (internal carotid artery) of twenty‐three patients were collected and sent to Olink Proteomics (Olink Proteomics, Boston, Massachusetts, USA) for analysis of protein expression of 92 cardiometabolic proteins and 92 inflammatory proteins. To determine which proteins had the most significant changes based on MOCA scoring, a series of 184 paired t‐tests were performed. Within each panel, proteins were then ranked based on the associated p values. Benjamini and Hochberg’s linear step‐up procedure was used to control the false discovery rate at 0.05. Pearson Correlation revealed proteins that were significantly related to the patients’ s discharge MOCA score as well as 90‐day follow‐up MOCA. Data and network analyses were performed using IBM SPSS Statistics, SAS v 9.4, and STRING V11. Common proteins between the discharge day miniMoCA and 90 days MOCA were identified. Network of these protein associations was created and biological processes correlating with these networks were identified. Results : Twenty‐two patients (15 with discharge day MiniMOCA and 7 with 90 days MOCA) were included in the analysis. Of these patients, 14 were females, and 9 were obese (BMI>30). 2 had minor stroke (NIHSS: 1–4), 13 had moderate stroke at admission (NIHSS: 5–15), 4 had moderate to severe stroke (NIHSS: 16–20), and 2 patients had severe stroke (NIHSS > 21). 19 patients had associated comorbidities (hypertension, diabetes, and hyperlipidemia). Mean last known normal to thrombectomy completion time was 621 + 333 minutes and mean infarct volume was 18,271 + 16,534 mm3. The 9 overlapping proteins from discharge to 90‐day follow up were later analyzed using interconnected STRING to determine association network and proteomic biological functions. Nine proteins include: DPP4, NCAM1, TGFBI, PRCP, APOM, TIE1, QPCT, MEGF9, and IGFBP3. Biological processes relating to the network of 9 proteins are depicted in table 1. Conclusions : This study uncovers network proteins that play a significant role in cognitive outcomes following ischemic stroke. This will allow future studies to develop predictive biomarkers for treatment and proteomic targets for adjunctive therapies to thrombectomy to improve our ability to treat cognitive dysfunction in ELVO stroke patients.

scholarly journals Initial experience with React 68 aspiration catheter

2020 ◽  
Vol 26 (3) ◽  
pp. 358-363
Author(s):  
Scott B Raymond ◽  
Mehr Nasir-Moin ◽  
Matthew J Koch ◽  
James D Rabinov ◽  
Thabele Leslie-Mazwi ◽  
...  
Keyword(s):  
Performance Measures ◽  
Posterior Circulation ◽  
Large Vessel ◽  
Initial Experience ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Patient Demographics ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Comparable Period

Introduction We describe our initial experience with the React 68 catheter (Medtronic, Dublin, Ireland), an FDA-approved catheter designed for aspiration in cases of emergent large vessel occlusion, as compared with the ACE 68 catheter (Penumbra, Alameda, CA). Methods This observational study followed consecutive patients treated with the React catheter over a seven-month period at a comprehensive stroke center. Use of the device was per discretion of the operator. Patient demographics, thrombectomy technique, reperfusion scoring, and disposition were assessed. Performance was compared with patients treated with the ACE 68 catheter over a comparable period. Results We treated 47 patients using the React 68 catheter using either aspiration alone or a combination of aspiration and stent retriever technique. The catheter was used in a variety of circumstances including proximal and distal occlusions involving the anterior and posterior circulation. Modified TICI 2b-3 was achieved in 45 of the 47 patients. The React 68 was comparable to the ACE 68 by all performance measures. Conclusion The React 68 catheter is a large-bore reperfusion catheter with trackability suitable for use in direct aspiration for recanalization of emergent large vessel occlusion.

Front-line thrombectomy for acute large-vessel occlusion with underlying severe intracranial stenosis: stent retriever versus contact aspiration

2020 ◽  
Vol 132 (4) ◽  
pp. 1202-1208 ◽  
Author(s):  
Dong-Hun Kang ◽  
Woong Yoon ◽  
Byung Hyun Baek ◽  
Seul Kee Kim ◽  
Yun Young Lee ◽  
...  
Keyword(s):  
Binary Logistic Regression ◽  
Stent Retriever ◽  
Large Vessel ◽  
Binary Logistic Regression Analysis ◽  
Large Vessel Occlusion ◽  
Front Line ◽  
Vessel Occlusion ◽  
Aspiration Thrombectomy ◽  
Atherosclerotic Stenosis ◽  
Antegrade Flow

OBJECTIVEThe optimal front-line thrombectomy choice for primary recanalization of a target artery remains unknown for patients with acute large-vessel occlusion (LVO) and an underlying intracranial atherosclerotic stenosis (ICAS). The authors aimed to compare procedural characteristics and outcomes between patients who received a stent-retriever thrombectomy (SRT) and patients who received a contact aspiration thrombectomy (CAT), as the front-line approach for treating LVO due to severe underlying ICAS.METHODSOne hundred thirty patients who presented with acute LVO and underlying severe ICAS at the occlusion site were included. Procedural characteristics and treatment outcomes were compared between patients treated with front-line SRT (n = 70) and those treated with front-line CAT (n = 60). The primary outcomes were the rate of switching to an alternative thrombectomy technique, time from groin puncture to initial reperfusion, and duration of the procedure. Initial reperfusion was defined as revealing the underlying culprit stenosis with an antegrade flow after thrombectomy.RESULTSThe rate of switching to an alternative thrombectomy after failure of the front-line technique was significantly higher in the CAT group than in the SRT group (40% vs 4.3%; OR 2.543, 95% CI 1.893–3.417, p < 0.001). The median time from puncture to initial reperfusion (17 vs 31 minutes, p < 0.001) and procedure duration (39 vs 75.5 minutes, p < 0.001) were significantly shorter in the SRT group than in the CAT group. In the binary logistic regression analysis, a longer time from puncture to initial reperfusion was an independent predictor of a 90-day poor (modified Rankin Scale score 3–6) functional outcome (per 1-minute increase; OR 1.029, 95% CI 1.008–1.050, p = 0.006).CONCLUSIONSThe authors’ results suggest that SRT may be more effective than CAT for identifying underlying culprit stenosis and therefore considered the optimal front-line thrombectomy technique in acute stroke patients with LVO and severe underlying ICAS.

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