Author:

Keywords:

Science & Technology, Life Sciences & Biomedicine, Clinical Neurology, Peripheral Vascular Disease, Neurosciences & Neurology, Cardiovascular System & Cardiology, acute stroke, fibrin, leukocytes, medical center, thrombectomy, Aged, Aged, 80 and over, Biomechanical Phenomena, Brain Ischemia, Endovascular Procedures, Female, Humans, Ischemic Stroke, Male, Middle Aged, Thrombectomy, Thrombosis, 1102 Cardiorespiratory Medicine and Haematology, 1103 Clinical Sciences, 1109 Neurosciences, Neurology & Neurosurgery, 3202 Clinical sciences, 3209 Neurosciences, 4201 Allied health and rehabilitation science

Abstract:

BACKGROUND AND PURPOSE: Mechanical properties of thromboemboli play an important role in the efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke. However, very limited data on mechanical properties of human stroke thrombi are available. We aimed to mechanically characterize thrombi retrieved with EVT, and to assess the relationship between thrombus composition and thrombus stiffness. METHODS: Forty-one thrombi from 19 patients with acute stroke who underwent EVT between July and October 2019 were mechanically analyzed, directly after EVT. We performed unconfined compression experiments and determined tangent modulus at 75% strain (Et75) as a measure for thrombus stiffness. Thrombi were histologically analyzed for fibrin/platelets, erythrocytes, leukocytes, and platelets, and we assessed the relationship between histological components and Et75 with univariable and multivariable linear mixed regression. RESULTS: Median Et75 was 560 (interquartile range, 393–1161) kPa. In the multivariable analysis, fibrin/platelets were associated with increased Et75 (aβ, 9 [95% CI, 5 to 13]) kPa, erythrocytes were associated with decreased Et75% (aβ, −9 [95% CI, −5 to −13]) kPa. We found no association between leukocytes and Et75. High platelet values were strongly associated with increased Et75 (aβ, 56 [95% CI, 38–73]). CONCLUSIONS: Fibrin/platelet content of thrombi retrieved with EVT for acute ischemic stroke is strongly associated with increased thrombus stiffness. For thrombi with high platelet values, there was a very strong relationship with thrombus stiffness. Our data provide a basis for future research on the development of next-generation EVT devices tailored to thrombus composition.