Higher amounts of neutrophil elastase-positive cells within the thrombus were independently associated with the occurrence of multiple emboli (adjusted OR 4.6; 95% CI 1.1-19.7; P=0.041).
Observational (n=85)
Are thrombus histological components associated with periprocedural thrombus fragmentation in patients with anterior circulation stroke undergoing thrombectomy?
Higher neutrophil levels in thrombus tissue are associated with an increased risk of periprocedural thrombus fragmentation and lower rates of complete recanalization during stroke thrombectomy.
Odds Ratio: 4.6 (95% CI 1.1–19.7)
p-value: p=0.041
BACKGROUND AND PURPOSE: Periprocedural thrombus fragmentation is a relevant risk in endovascular stroke treatment. Because factors influencing its occurrence are largely unknown, this study addresses a potential relationship between thrombus histology and clot stability. MATERIALS AND METHODS: Eighty-five patients with anterior circulation stroke treated with thrombectomy were included in this retrospective study. The number and location of emboli after retrieving the primary thrombus, the number of maneuvers, and TICI scores were evaluated. H P = .032). Younger patients were at higher risk for periprocedural thrombus fragmentation (Spearman r, −0.23; P = .032). Bridging thrombolysis tended to be associated with fewer maneuvers (2 vs 3, P = .054) but more emboli (1 vs 0, P = .067). While no consistent correlation between procedural parameters and red/white blood cells and fibrin-/platelet fractions could be found, higher amounts of neutrophil elastase–positive cells within the thrombus were independently associated with the occurrence of multiple emboli (adjusted OR, 4.6; 95% CI, 1.1–19.7; P = .041) and lower rates of complete recanalization (adjusted OR, 0.3; 95% CI, 0.1–0.9; P = .050). CONCLUSIONS: Younger age, easy-to-retrieve thrombi, and bridging thrombolysis may be risk factors for periprocedural thrombus fragmentation. Findings from standard histologic stains did not provide insight into thrombectomy-relevant thrombus stability. However, higher neutrophil levels in the thrombus tissue were related to an increased risk of periprocedural thrombus fragmentation. This observation aligns with the proposed thrombolytic capacity of neutrophil elastase and points to its potential clinical relevance in the context of stroke thrombectomy.
Kaesmacher et al. (Thu,) conducted a observational in Anterior circulation stroke (n=85). Higher amounts of neutrophil elastase-positive cells within the thrombus was evaluated on Occurrence of multiple emboli (periprocedural thrombus fragmentation) (adjusted OR 4.6, 95% CI 1.1-19.7, p=0.041). Higher amounts of neutrophil elastase-positive cells within the thrombus were independently associated with the occurrence of multiple emboli (adjusted OR 4.6; 95% CI 1.1-19.7; P=0.041).