PB0031 - Association between thromboembolus composition and first pass recanalisation after thrombectomy in ischemic stroke

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Co-Author(s)

SS

Senna Staessens

PhD
Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk
Kortrijk, West-Vlaanderen, Belgium

Presenting Author(s)

Sarah Vandelanotte, MA

Phd student
Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
kortrijk, West-Vlaanderen, Belgium

Co-Author(s)

OF

Olivier Francois

MD
Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
kortrijk, West-Vlaanderen, Belgium
EB

Eric Boulleaux

Laboratory assistant
University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, F-59000 Lille, France
Lille, Nord-Pas-de-Calais, France
MB

Martin Bretzner

MD, MSc
University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, F-59000 Lille, France
Lille, Nord-Pas-de-Calais, France
BC

Barbara Casolla

MD, PhD
University of Lille, Inserm, CHU Lille, U1172 – LilNCog – Lille Neuroscience & Cognition / Stroke Unit, UR2CA-URRIS Neurology, CHU Pasteur 2, Nice Cote d’Azur University, Nice, France.
Lille, Nord-Pas-de-Calais, France
DC

Delphine Corseaux

professor
University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, F-59000 Lille, France
Lille, Nord-Pas-de-Calais, France
LP

Laurent Puy

MD
University of Lille, Inserm, CHU Lille, U1172 – LilNCog – Lille Neuroscience & Cognition, F-59000 Lille, France
Lille, Nord-Pas-de-Calais, France
LD

Linda Desender

Lab technician
Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk
Kortrijk, West-Vlaanderen, Belgium
TD

Tom Dewaele

MD
Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
Kortrijk, West-Vlaanderen, Belgium
CT

Claudia Tersteeg

Prof., Dr.
Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
Kortrijk, West-Vlaanderen, Belgium
Karen Vanhoorelbeke, PhD

Prof., Dr.
Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
Kortrijk, West-Vlaanderen, Belgium
PV

Peter Vanacker

MD
Department of Neurology, AZ Groeninge, Kortrijk, Belgium / Neurovascular Center and Stroke Unit Antwerp, Antwerp University Hospital, Antwerp, Belgium. / Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
Kortrijk, West-Vlaanderen, Belgium
Sophie Susen, MD, PhD

Professor, MD, PhD
CRC-MHC, Lille University Hospital, Lille, France
Lille, Nord-Pas-de-Calais, France
CC

Charlotte Cordonnier

Professor
Univ. Lille, Inserm, CHU Lille, U1172
Lille, Nord-Pas-de-Calais, France
TA

Tommy Andersson

MD
Departments of Neuroradiology, Karolinska University Hospital, and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
Stockholm, Stockholms Lan, Sweden
SD

Simon F. De Meyer

Prof., Dr., Eng.
Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
Kortrijk, West-Vlaanderen, Belgium

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.