Absence of susceptibility vessel sign is associated with aspiration-resistant fibrin/platelet-rich thrombi. Issue 8 (October 2021)

• Record Type: Journal Article
• Authors: Darcourt, Jean; Garcia, Cédric; Phuong, Do M; Michelozzi, Caterina; Bellanger, Guillaume; Adam, Gilles; Roques, Margaux; Januel, Anne C; Tall, Philippe; Albucher, Jean F; Olivot, Jean M; Bonneville, Fabrice; Payrastre, Bernard; Cognard, Christophe
• Is Part Of: International journal of stroke. Volume 16:Issue 8(2021)
• Page Start: 972
• Page End: 980
• Publication Date: 2021-10
• Subjects: Aspiration -- histology -- stent retriever -- stroke -- SVS -- thombectomy -- thrombus; 616.8005
• DOI: 10.1177/1747493020986626
• Languages: English
• ISSNs: 1747-4930

Abstract

Background: The composition of the thrombus influences its retrievability by mechanical thrombectomy. Purpose: Our study aimed to report on thrombi resistant to aspiration, regarding susceptibility vessel sign and histologic composition. Methods: This observational study was based on a prospective database of acute anterior circulation ischemic strokes treated by mechanical thrombectomy. Endovascular first-line strategy was aspiration and in case of failure, combined therapy-rescue was performed. The positivity of susceptibility vessel sign (SVS+) or its negativity (SVS−) was assessed on T2* sequences. The thrombus composition was analyzed with hematoxylin eosin staining. Results: Histological analysis was performed on 102 clots. Thrombi with SVS− were significantly richer in fibrin/platelets, p = 0.04. Out of 210 mechanical thrombectomy, aspiration first pass strategy was performed in 131/210 (62%) patients. Combined therapy-rescue was needed in 37% of aspiration first pass strategy cases ( n = 131). Clots retrieved combined therapy-rescue were richer in fibrin/platelets 63.9% versus 50.8% for aspiration first pass strategy, p = 0.03. Logistic regression analysis showed that fibrin/platelet-poor clots (<60%) were significantly more likely to be recanalized by aspiration first pass strategy compared to fibrin/platelet-rich clots (>60%) that were more likely recanalized by combined therapy-rescue after aspiration first pass strategy failure (OR = 3.5; 95% CI = 1.2–10.8; p = 0.0054). Conclusions: Our results confirm that SVS− clots are rich in fibrin/platelets and suggest that these "white clots" are less likely to be retrieved by aspiration alone and more often require the use of combined therapy.