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Erythrocyte Fraction Within Retrieved Thrombi Contributes to Thrombolytic Response in Acute Ischemic Stroke

Authors
Choi, MH; Park, GH; Lee, JS; Lee, SE; Lee, SJ; Kim, JH; Hong, JM
Citation
Stroke, 49(3):652-659, 2018
Journal Title
Stroke
ISSN
0039-24991524-4628
Abstract
BACKGROUND AND PURPOSE: Recent advent of endovascular thrombectomy (EVT) enables us to provide a new perspective on the use of tPA (tissue-type plasminogen activator) through histological analysis of retrieved thrombus. We investigated the responsiveness of intravenous thrombolysis (IVT) according to the thrombus composition in EVT-attempted patients with acute ischemic stroke.
METHODS: We reviewed 92 consecutive patients with anterior circulation stroke who received combined IVT and EVT for 2 years. IVT responsiveness is defined as any decrease in the clot burden from baseline computed tomographic angiography to digital subtraction angiography during EVT. We histologically analyzed the relative fractions of red blood cells (RBCs), congregated fibrin and platelets, and white blood cells in the retrieved thrombi using semiautomated color-based segmentation method. Clinical characteristics according to the RBC fraction were investigated, and associated factors with IVT responsiveness were explored.
RESULTS: Fifty-two patients with histological analyses were stratified into lowest, middle, and highest tertiles of RBC fraction. Toward higher RBC fraction, there was more common susceptibility vessel signs on magnetic resonance imaging (50.0% versus 66.7% versus 91.7%: P=0.022) and prevalent IVT responsiveness (25.0% versus 41.7% versus 75.0%: P=0.010). IVT-responsive group (n=23) had higher RBC fraction (45.7+/-15.5% versus 35.9+/-12.2%: P=0.010), lower fibrin and platelet (50.4+/-14.0% versus 58.5+/-11.1%: P=0.027), and lower white blood cells fraction (3.9+/-2.1% versus 5.5+/-3.0%: P=0.027) than IVT-unresponsive group (n=29). After adjusting for potential variables, RBC fraction (odds ratio, 1.05: 95% confidence interval, 1.01-1.10) remained only independent determinant of IVT responsiveness.
CONCLUSIONS: In EVT-attempted patients with acute ischemic stroke, IVT responsiveness would be closely associated with RBC fraction.
Keywords
blood plateletserythrocytesfibrinolysisstrokethrombectomy
MeSH terms
AgedBrain Ischemia*/diagnostic imagingBrain Ischemia*/drug therapyCerebral Angiography*Computed Tomography Angiography*Erythrocytes*FemaleHumansMagnetic Resonance Angiography*MaleMiddle AgedRetrospective StudiesStroke*/diagnostic imagingStroke*/drug therapyThrombolytic Therapy*/adverse effectsThrombolytic Therapy*/methodsThrombosis*/diagnostic imagingThrombosis*/etiologyTissue Plasminogen Activator/therapeutic use*
DOI
10.1161/STROKEAHA.117.019138
PMID
29374103
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Neurology
Journal Papers > School of Medicine / Graduate School of Medicine > Emergency Medicine
Journal Papers > School of Medicine / Graduate School of Medicine > Pathology
AJOU Authors
최, 문희이, 진수이, 성은이, 성준김, 장희홍, 지만
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