Abstract Number: PB0031
Meeting: ISTH 2022 Congress
Background: When performing thrombectomy on ischemic stroke patients, achieving good recanalisation in the first pass (first pass effect, FPE) is associated with a good clinical outcome. Achieving FPE has therefore become an important objective of the procedure. The reasons why multiple attempts are sometimes needed are not fully understood, but the composition of the thromboembolus is considered to be an important factor.
Aims: The aim of this study was to investigate the link between thromboembolus composition and FPE.
Methods: In total, 497 stroke thromboemboli from the AZ Groeninge Hospital (Kortrijk, Belgium) and CHU Lille (Lille, France) were analysed histologically for 7 components: red blood cells (RBC), fibrin, von Willebrand factor, platelets, leukocytes, citrullinated histone 3 (marker for neutrophil extracellular traps) and DNA (intra- and extracellular). FPE was defined as obtaining a modified Thrombolysis in Cerebral Ischemia (mTICI) score of 2c/3 after the first pass. Thromboembolus histology was compared between cases in which a FPE was achieved and cases in which a mTICI score of 2c/3 was achieved after multiple passes.
Results: Good recanalisation (mTICI 2c/3) was obtained in 348 patients: 208 with an FPE and 140 needing multiple passes. Patients in which no good recanalisation was obtained (n= 149) were excluded for this analysis. Interestingly, thromboemboli from FPE cases contained significantly more RBC (median (IQR): 44.74% (29.53%-58.13%) versus 39.85% (24.99%-52.88%), p=0.02) compared with patients in which multiple passes were needed. In addition, achieving an FPE was associated with better clinical outcome indicated by a lower modified ranking score at 90 days (median (IQR): 2 (1-3) vs 3 (1-5), p=0.0003).
Conclusion(s): Achieving an FPE is more likely in patients with RBC-richer thromboemboli and achieving an FPE results in better clinical outcome. Future research and technical improvements are needed to improve FPE-rates in RBC-poor thromboemboli.
To cite this abstract in AMA style:Staessens S, Vandelanotte S, François O, Boulleaux E, Bretzner M, Casolla B, Corseaux D, Puy L, Desender L, Dewaele T, Tersteeg C, Vanhoorelbeke K, Vanacker P, Susen S, Cordonnier C, Andersson T, De Meyer S. Association between thromboembolus composition and first pass recanalisation after thrombectomy in ischemic stroke [abstract]. https://abstracts.isth.org/abstract/association-between-thromboembolus-composition-and-first-pass-recanalisation-after-thrombectomy-in-ischemic-stroke/. Accessed September 26, 2022.
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