Following thrombectomy in patients with acute ischemic stroke, adhesive and mechanical interactions are frequently observed between the thrombus and stent retriever, according to an analysis published in the Journal of the American Heart Association. Adhesive interactions may be the strongest interaction, researchers reported, which is associated with a denser thrombus surface.
A total of 7 stent-retrievers with entrapped thrombi were obtained following thrombectomy interventions included in the MR-CLEAN (A Multicenter Clinical Registry of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands) registry. The investigators used microcomputed tomography (micro-CT) to study the stent-retrievers and the total volume of the thrombi was assessed using semi-automated analysis software. In the study, 2 independent researchers observed and rated the interaction type of thrombus surface structure at each of the interaction sites.
Observers identified 79 interaction sites (median per stent-retriever 11 [4 to 27]). In 56% of interaction sites, the adhesive type was found in the thrombus-stent-retriever interaction, whereas 44% of thrombus-stent-retriever interaction was found to be mechanical. In addition, interaction sites with a dense surface were more likely to feature the adhesive interaction compared with the adhesive interaction at porous filamentous surface sites (P =.011).
The study’s main limitation was its lack of analysis for determining whether thrombus composition and fibrin content affect the behavior of thrombus during a mechanical thrombectomy. In addition, the study may be limited by its small sample of patients with acute ischemic stroke.
Findings from this study may elucidate “[a] better understanding of stent-thrombus interaction [that] could lead to improved efficacy of mechanical thrombectomy devices.”
Autar ASA, Hund HM, Ramlal SA, et al; on behalf of the MR CLEAN Registry Investigators. High-resolution imaging of interaction between thrombus and stent-retriever in patients with acute ischemic stroke. J Am Heart Assoc. 2018;7(13).